| NPI | 1124489968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE BOULTER Manager 801-995-1235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 5192637-1206) |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2016-03-07 |