JUSTIN D. PROVO

SALT LAKE CITY, UT
NPI1720548670
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy208100000X Physical Medicine & Rehabilitation
(Licence: UT  12017642-1205)
Enumeration Date2019-03-25
Last Update Date2020-11-05
Business Address
JUSTIN D. PROVO MD
30 N 1900 E RM 1C301
SALT LAKE CITY, UT 84132-0002
Phone number: 801-585-2589
Mailing Address
JUSTIN D. PROVO MD
30 N 1900 E RM 1C301
SALT LAKE CITY, UT 84132-0002
Phone number: 801-585-2589
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