| NPI | 1811447725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE CRAIG SOLOMON Manager 801-652-4437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: UT 8202232-3501) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2016-10-04 |