| NPI | 1518108166 |
|---|---|
| Doing Business As | SOUTHRIDGE CLINIC PEDIATRICS |
| Entity Type | Organization |
| Authorized Contact | LINDA C LECKMAN CEO Intermountain Medical Group 801-442-3974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 5722009) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2016-03-15 |