| NPI | 1285016972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SPENCER D CHENEY Manager/Member 801-425-2065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: UT 5309691-1202) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2016-04-07 |