| NPI | 1679956445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUGENE DOUGLAS LARSEN President 801-309-5156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: UT 93369771204) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2015-08-10 |