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 |