| NPI | 1619240561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLA LARSEN Manager 801-566-4357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: UT 165972-1202) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2019-05-29 |