Provider First Line Business Practice Location Address:
620 E. WILMINGTON AVE.
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:
84106-1421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-466-2884
Provider Business Practice Location Address Fax Number:
801-466-2884
Provider Enumeration Date:
12/12/2006