| NPI | 1447400114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY MARK SHEPHERD Owner 801-636-7499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: UT 71183171202) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2010-06-03 |