| NPI | 1730326919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA LYNN NEWBERRY Owner 801-525-6975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: UT 6810992-0162) |
| Enumeration Date | 2009-01-09 |
| Last Update Date | 2009-01-09 |