| NPI | 1710496310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHOT VACHAROTHONE CEO 801-260-1919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QU0200X Clinic/Center Urgent Care |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2018-07-24 |