Provider First Line Business Practice Location Address:
UNIVERSITY OF UTAH DEPARTMENT OF MEDICINE
Provider Second Line Business Practice Location Address:
30 N 1900 E SOM RM 4C116
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:
84132-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-585-5559
Provider Business Practice Location Address Fax Number:
801-585-0418
Provider Enumeration Date:
04/20/2015