| NPI | 1265677678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD K MADSEN Employer 435-637-7551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: UT 1612038905) |
| Enumeration Date | 2008-12-14 |
| Last Update Date | 2008-12-14 |