Provider First Line Business Practice Location Address:
508 E SOUTH TEMPLE
Provider Second Line Business Practice Location Address:
STE. 300
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:
84102-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-524-4500
Provider Business Practice Location Address Fax Number:
801-359-1665
Provider Enumeration Date:
03/29/2006