| NPI | 1417467986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WARREN ALBERT PETERERSON Owner 435-703-9296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 179077-1204) |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2018-03-08 |