Provider First Line Business Practice Location Address:
UNIVERSITY OF UTAH
Provider Second Line Business Practice Location Address:
DIVISION OF ID; 30 N 1900 E
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:
801-587-3567
Provider Business Practice Location Address Fax Number:
801-585-7315
Provider Enumeration Date:
11/15/2005