| NPI | 1053764431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED PROBST President 801-277-2682 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: UT 98642974405) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2016-07-20 |