| NPI | 1104270768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCO JURACAN Owner 801-310-3091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: UT 2391843-6004) |
| Additional Taxonomies | 251S00000X (Licence: UT 8937085-6009) |
| 251S00000X (Licence: UT 8155586-6004) | |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2016-04-20 |