| NPI | 1457599912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAN HIBBERT Manager 801-822-2727 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: UT 7100427-1205) |
| Additional Taxonomies | 261QL0400X Clinic/Center, Lithotripsy (Licence: UT 7100427-1205) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2019-09-25 |