| NPI | 1164063277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN KNEPPER Owner 435-604-0160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2019-10-01 |