Provider First Line Business Practice Location Address:
2401 S FOOTHILL DR STE C
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:
84109-1479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-418-0730
Provider Business Practice Location Address Fax Number:
801-505-0380
Provider Enumeration Date:
04/23/2013