| NPI | 1205013455 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIKKI OLDHAM Operations Supervisor 435-755-6061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 4371-A) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2011-10-25 |