Provider First Line Business Practice Location Address:
1106 E 6600 S
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:
84121-2446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
385-429-8200
Provider Business Practice Location Address Fax Number:
801-327-7064
Provider Enumeration Date:
07/26/2019