Provider First Line Business Practice Location Address:
2290 SOUTH 1300 EAST
Provider Second Line Business Practice Location Address:
MEDICAL MARTS
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:
84106-2831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-474-0800
Provider Business Practice Location Address Fax Number:
810-467-1126
Provider Enumeration Date:
07/07/2006