| NPI | 1669826749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANANNE JOHNSONTALBERT Owner 801-669-3425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: UT 8052012-0162) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2016-04-14 |