Provider First Line Business Practice Location Address:
974 E SOUTH TEMPLE
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:
84102-1413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-533-0070
Provider Business Practice Location Address Fax Number:
801-596-2240
Provider Enumeration Date:
11/17/2011