NPI | 1043485188 |
---|---|
Entity Type | Organization |
Authorized Contact | GREGORY LEWIS HADDOCK Owner 801-268-4993 |
Organization Subpart ? | No |
Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: UT 57703761202) |
Enumeration Date | 2008-04-29 |
Last Update Date | 2008-04-29 |