NPI | 1639347677 |
---|---|
Entity Type | Organization |
Authorized Contact | JUSTIN BRUCE TRAVELLER Owner 435-563-4772 |
Organization Subpart ? | No |
Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: UT 6859851-1202) |
Enumeration Date | 2008-02-12 |
Last Update Date | 2008-03-03 |