NPI | 1326274507 |
---|---|
Entity Type | Organization |
Authorized Contact | RYAN HAROLD LARSEN Physician 435-753-1171 |
Organization Subpart ? | Yes |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: UT 175141-1205) |
Enumeration Date | 2009-06-02 |
Last Update Date | 2009-06-02 |