Provider First Line Business Practice Location Address:
1250 E 3900 S STE 410
Provider Second Line Business Practice Location Address:
ST. MARK'S EAST MEDICAL BUILDING
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:
84124-1364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-281-5996
Provider Business Practice Location Address Fax Number:
801-281-6713
Provider Enumeration Date:
02/26/2007