| NPI | 1467830281 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARCE LATSIS Operations Manager 801-441-1002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: UT 70619161204) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2020-01-30 |