| NPI | 1790906204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN LARSON Owner 801-328-2522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: UT 20042178) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2024-05-21 |