| NPI | 1053441238 |
|---|---|
| Doing Business As | SOUTHRIDGE KIDSCARE |
| Entity Type | Organization |
| Authorized Contact | LINDA C LECKMAN CEO Intermountain Medical Group 801-442-3974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 2005200) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2009-08-31 |