| NPI | 1093308397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL FRAGA Contracting Manager 801-921-6325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QI0500X Clinic/Center, Infusion Therapy |
| Enumeration Date | 2021-02-17 |
| Last Update Date | 2024-09-13 |