| 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 |