| NPI | 1669252268 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISA ANDERSON Manager 801-919-3008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2024-04-24 |