| NPI | 1669930475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JED BRADLEY HARSTON Director Of Payer Relations 801-812-5012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2019-03-11 |