Provider First Line Business Practice Location Address:
4600 S. HIGHLAND DRIVE
Provider Second Line Business Practice Location Address:
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:
84117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-272-1892
Provider Business Practice Location Address Fax Number:
801-284-2960
Provider Enumeration Date:
05/19/2009