DISA T. BROCK

PROVO, UT
NPI1154961746
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy2084P0800X Psychiatry & Neurology Psychiatry
(Licence: UT  9093412-4408)
Enumeration Date2020-01-10
Last Update Date2020-01-10
Business Address
DISA T. BROCK
2520 N UNIVERSITY AVE # 250A
PROVO, UT 84604-3804
Phone number: 801-337-8277
Mailing Address
DISA T. BROCK
1211 E 2080 N
PROVO, UT 84604-2147
Phone number: 801-753-5543
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