| NPI | 1790173615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EZRA L. NIELSEN Manager 435-633-6750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: UT 186597-4405) |
| Enumeration Date | 2014-12-30 |
| Last Update Date | 2014-12-30 |