| NPI | 1376680603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILSON RICHARD BARTON Overseer 801-974-5644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: UT 176317-1202) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2020-08-22 |