| NPI | 1467988832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER PATRICK KELLY Medical Director/Owner 801-987-8653 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: UT 9258138-1205) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2017-05-04 |