Provider First Line Business Practice Location Address:
380 S 1530 E RM 502
Provider Second Line Business Practice Location Address:
UNIVERSITY OF UTAH
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84112-0259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-7559
Provider Business Practice Location Address Fax Number:
801-581-5841
Provider Enumeration Date:
06/13/2007