Registry details
Type
Individual
Primary specialty
Orthopaedic Surgery
Enumerated
Mar 19, 2019
License(s)
1275092108 (IL), 13877446-1205 (UT)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 590 S WAKARA WAY RM A0058 | Salt Lake City, UT 84108-1200 | 801-581-2121 |
| MAILING | 590 S WAKARA WAY RM A0058 | Salt Lake City, UT 84108-1200 | 801-581-2121 |
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