| NPI | 1639592611 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY LANCE CEO 801-987-8384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 214109-4405) |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2014-01-28 |