Provider First Line Business Practice Location Address:
5089 S. 900 E.
Provider Second Line Business Practice Location Address:
SUITE 100
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:
84117-5731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-743-0700
Provider Business Practice Location Address Fax Number:
801-743-0701
Provider Enumeration Date:
12/02/2008