| NPI | 1730517517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHUNG CHAU Owner Manager 801-541-6807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: UT 5660293-9922) |
| Enumeration Date | 2013-10-14 |
| Last Update Date | 2013-10-14 |