Provider First Line Business Practice Location Address:
50 N MEDICAL DR
Provider Second Line Business Practice Location Address:
NBICU 2ND FLOOR ROOM 2705
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:
84132-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-585-7970
Provider Business Practice Location Address Fax Number:
801-581-5060
Provider Enumeration Date:
02/07/2007