| NPI | 1356395586 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN H. CHARLTON M.D. Manager Member 801-277-2062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: UT 2006-ASF-74408) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2014-07-08 |