| NPI | 1811973589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANECE FICKETT FICKETT Administrator 801-773-3339 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: UT 2004-ASF-909) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2012-03-28 |