NPI | 1093199754 |
---|---|
Entity Type | Organization |
Authorized Contact | LORIN MICKELSEN Resident 801-928-0401 |
Organization Subpart ? | No |
Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: KY 00433) |
Enumeration Date | 2015-07-13 |
Last Update Date | 2015-07-13 |