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1770872319
MARY-MARIE AUSTIN SULLIVAN
PROVO, UT
NPI
1770872319
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Former Name
MARY-MARIE AUSTIN
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: UT 8380179-1205)
Enumeration Date
2011-04-05
Last Update Date
2021-09-14
Business Address
MARY-MARIE AUSTIN SULLIVAN MD
1134 N 500 W STE 102
PROVO, UT 84604-5569
Phone number: 801-341-5200
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Mailing Address
MARY-MARIE AUSTIN SULLIVAN MD
PO BOX 27128
SALT LAKE CITY, UT 84127-0128
Phone number: 801-341-5200
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