| NPI | 1447397658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL D GELLER Owner 801-963-2773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: UT 921111919934) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2023-03-24 |