Provider First Line Business Practice Location Address:
1141 EAST 3900 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-284-4900
Provider Business Practice Location Address Fax Number:
801-284-4901
Provider Enumeration Date:
04/01/2011