Provider First Line Business Practice Location Address:
166 E 5900 S
Provider Second Line Business Practice Location Address:
STE B106
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:
84107-7350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-743-6444
Provider Business Practice Location Address Fax Number:
801-743-6888
Provider Enumeration Date:
06/22/2005