Provider First Line Business Practice Location Address:
451 BISHOP FEDERAL LANE
Provider Second Line Business Practice Location Address:
CHRISTUS ST JOSEPHS VILLA
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-493-8903
Provider Business Practice Location Address Fax Number:
801-468-6843
Provider Enumeration Date:
11/17/2006