Provider First Line Business Practice Location Address:
24 SOUTH 600 EAST
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:
84102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-231-3003
Provider Business Practice Location Address Fax Number:
801-521-0688
Provider Enumeration Date:
10/24/2006