| NPI | 1639754583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRIS COLEMAN Coc 435-770-2131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2021-03-12 |
| Last Update Date | 2023-12-12 |