CHARLES ELLISON

PROVO, UT
NPI1225419682
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy171M00000X Case Manager/Care Coordinator
(Licence: UT  179122236)
Enumeration Date2015-06-11
Last Update Date2015-06-11
Business Address
-- CHARLES ELLISON
750 N FREEDOM BLVD
PROVO, UT 84601-1677
Phone number: 801-373-4760
Mailing Address
-- CHARLES ELLISON
750 N FREEDOM BLVD
PROVO, UT 84601-1677
Phone number:
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