| NPI | 1265674246 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER PAYNE Medicare Enrollment Specialist 801-442-8468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2011-04-14 |