Provider First Line Business Practice Location Address:
4A330 SCHOOL OF MEDICINE
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:
84132-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-6465
Provider Business Practice Location Address Fax Number:
801-581-6484
Provider Enumeration Date:
09/23/2005