Provider First Line Business Practice Location Address:
4970 SO 900 E STE 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:
84117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-268-9722
Provider Business Practice Location Address Fax Number:
801-264-9662
Provider Enumeration Date:
11/02/2006