Provider First Line Business Practice Location Address:
1020 S MAIN ST
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:
84101-3176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-539-7000
Provider Business Practice Location Address Fax Number:
801-539-7076
Provider Enumeration Date:
12/30/2005