| NPI | 1063184422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA TANDY Director 801-787-0731 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QI0500X Clinic/Center, Infusion Therapy |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2024-01-04 |