| NPI | 1114224805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN AGRES Owner 801-430-8406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 7259622-0501) |
| Enumeration Date | 2011-02-16 |
| Last Update Date | 2024-04-15 |