Provider First Line Business Practice Location Address:
420 E SOUTH TEMPLE STE 220
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:
84111-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-355-3286
Provider Business Practice Location Address Fax Number:
801-355-1320
Provider Enumeration Date:
08/29/2006