| NPI | 1538391339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUDREY JANTZEN Manager 801-229-1054 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: UT 66542191205) |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2009-08-13 |