Provider First Line Business Practice Location Address:
1524 S 1100 E
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:
84105-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-467-1200
Provider Business Practice Location Address Fax Number:
801-467-1210
Provider Enumeration Date:
10/17/2013