| NPI | 1053773770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK D JOHNSON Office Manager 1801-265-2212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: UT 0016571) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2016-11-08 |