Provider First Line Business Practice Location Address:
CTA COMMUNITY SUPPORTS 4444 S
Provider Second Line Business Practice Location Address:
700 E SUITE 203
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:
84107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-268-4887
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2017