| NPI | 1578027470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL FRAGA Credentialing Contracting Manager 801-590-9267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QI0500X Clinic/Center, Infusion Therapy |
| Enumeration Date | 2019-01-24 |
| Last Update Date | 2023-05-26 |