| NPI | 1407187974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE R. WATERS Sole Member 801-597-7673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: UT 5087227-6004) |
| Enumeration Date | 2010-01-24 |
| Last Update Date | 2010-01-24 |