| NPI | 1073909594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIANA ANDERSON HANKINS Administrator 801-888-1140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 88335211205) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2024-02-05 |