| NPI | 1457863912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANIE WARD Owner 801-513-3223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: UT 4972C) |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2021-04-05 |