Provider First Line Business Practice Location Address:
8 TH AVENUE AND C ST
Provider Second Line Business Practice Location Address:
INTERMOUNTAIN LDS HOSPITAL-CRITICAL CARE MEDICINE
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:
84143-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-408-3663
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2005