| NPI | 1821428921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADY J OLSEN Owner 801-298-1101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: UT 7270739-9922) |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2013-11-26 |