Provider First Line Business Practice Location Address:
VA MEDICAL CTR
Provider Second Line Business Practice Location Address:
116, 500 FOOTHILL DRIVE
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:
84148-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-582-1565
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2006