Provider First Line Business Practice Location Address:
327 DENVER 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:
84111-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-328-4500
Provider Business Practice Location Address Fax Number:
801-328-4565
Provider Enumeration Date:
03/31/2006