| NPI | 1376944942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED REX HEATON Physician 435-770-9247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: UT 9017921-1204) |
| Enumeration Date | 2014-09-14 |
| Last Update Date | 2014-09-14 |