Provider First Line Business Practice Location Address:
5121 S COTTONWOOD ST
Provider Second Line Business Practice Location Address:
IM WOMEN AND CHILDREN ADMINISTRATION 15400-15541
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84107-5701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-507-7673
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2015