| NPI | 1750569562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY PEACOCK Owner 435-655-3309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: UT 5151398-1205) |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2011-05-18 |