| NPI | 1659012292 |
|---|---|
| Doing Business As | DOCTOR/OWNER |
| Entity Type | Organization |
| Authorized Contact | MICHAEL KIRK MOORE Owner 801-685-2730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2022-04-06 |