| NPI | 1376645671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN A TERRY Medical Director 801-587-6833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2020-08-22 |