| NPI | 1396199972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA THATCHER Billing 801-359-2256 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: UT 9453799-8906) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2025-12-11 |