| NPI | 1699075895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL B VINE Md 801-288-1115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: UT 171413-1205) |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2010-10-22 |