| NPI | 1215310024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF GARCIA Program Manager 801-441-1002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: UT 94364451725) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2015-06-30 |