Provider First Line Business Practice Location Address:
1473 S 600 E
Provider Second Line Business Practice Location Address:
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:
84105-2062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-487-1010
Provider Business Practice Location Address Fax Number:
801-487-1015
Provider Enumeration Date:
12/19/2012