| NPI | 1538572169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DRAKE G VINCENT Medical Director 801-942-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: UT 5767298-8905) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2014-06-11 |