Provider First Line Business Practice Location Address:
UNIVERSITY OF UTAH MED CTR STE 2B200, 30 N 1900 E
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:
84132-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-213-3716
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2025