| NPI | 1710395140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WADE CHRISTIANSEN Owner 801-766-9947 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: UT 83244110501) |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2014-10-01 |