| NPI | 1437671583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY Q. JACKSON Owner 801-430-0282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 293D00000X Physiological Laboratory (Licence: UT 7382930-0160) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2018-06-16 |