| NPI | 1295028603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT WALLACE CHALMERS Medical Director 435-656-1916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X (Licence: UT 6626848-1205) |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2011-05-17 |