| NPI | 1265269328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISA ANDERSON Billing Credentialing Admin 801-561-8398 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| Enumeration Date | 2024-09-13 |
| Last Update Date | 2024-09-13 |