| NPI | 1073892659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER CADE BRODERICK Manager 801-804-5342 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: UT 7952725-1202) |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2011-08-12 |