Provider First Line Business Practice Location Address:
12000 E BIG COTTONWOOD CANYON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84121-9710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-533-2002
Provider Business Practice Location Address Fax Number:
801-323-9546
Provider Enumeration Date:
11/10/2011