| NPI | 1417118498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRIS I. DAVIS Director 801-475-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: UT 3376391202) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2008-06-23 |