Provider First Line Business Practice Location Address:
3495 S WEST TEMPLE
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:
84115-4338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-262-1552
Provider Business Practice Location Address Fax Number:
801-262-2066
Provider Enumeration Date:
08/23/2006