| NPI | 1396107348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERAH JONES Owner 801-671-5486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: UT 68732024405) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2016-03-28 |