| NPI | 1083209589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLBY LOUIS BEAL Vice President 801-850-1110 |
| Organization Subpart ? | |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2021-03-05 |