| NPI | 1043518012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONIQUE S ARAGON Compliance Admin Asst/ Credentialin 801-260-1919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2024-03-28 |