| NPI | 1427075134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARRY LONTINE Credentialing 801-855-0093 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| 122300000X Dentist | |
| 183500000X Pharmacist | |
| 207VX0000X Obstetrics & Gynecology, Obstetrics | |
| 103T00000X Psychologist | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2023-08-10 |