| NPI | 1326229816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEIF ERIK NIELSON President 435-654-5008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: UT 363980-1202) |
| Enumeration Date | 2007-11-26 |
| Last Update Date | 2017-10-23 |