| NPI | 1346205176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAN NIELSON Administrator 435-674-5230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: UT 2005-ASF-52092) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2017-06-09 |