| NPI | 1255769386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIE LUCKING Owner/Operator 801-253-6452 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: UT 774) |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2013-10-29 |