| NPI | 1326148073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN R DIETLEIN Medical Director 801-944-0095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: UT 169963-1205) |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2007-10-19 |