| NPI | 1700011954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA A FAIRCLOTH Owner 801-261-3975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 7256620-1205) |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2021-06-08 |