Provider First Line Business Practice Location Address:
2048 W 5400 S
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:
84118-1428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-968-5400
Provider Business Practice Location Address Fax Number:
801-968-5405
Provider Enumeration Date:
08/14/2008