| NPI | 1558653501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA LYNN DUNCAN Provider/Owner 801-668-4860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: UT 277575-4405) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2014-03-21 |