| NPI | 1487184610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY NOEL DE LA GARZA Owner 801-910-6189 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty (Licence: UT 10389489) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2017-06-20 |