Provider First Line Business Practice Location Address:
30 N. 1900 E., RM. 5R-110
Provider Second Line Business Practice Location Address:
UNIVERSITY OF UTAH DEPT. OF PSYCHIATRY
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:
84132-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-4096
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2011