| NPI | 1619048170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY E HANSEN Medical Director 435-637-1744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: UT 5249970-1704) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2008-06-05 |