| NPI | 1639466352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD R HASTIE Owner / Operator 801-564-7091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: UT 7994885-0162) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2011-07-01 |