Provider First Line Business Practice Location Address:
1737 NORTH 2000 WEST
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-728-9000
Provider Business Practice Location Address Fax Number:
801-728-9010
Provider Enumeration Date:
12/13/2012