Provider First Line Business Practice Location Address:
30 N 1900 E DEPT OF
Provider Second Line Business Practice Location Address:
SURGERY
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-3702
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2012