| NPI | 1275974149 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA R OLSON Owner 801-879-0369 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: AZ 47493) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2016-05-25 |