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1841600137
JACOB LOUIS PETERSON
TAYLORSVILLE, UT
NPI
1841600137
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2014-05-07
Last Update Date
2014-05-07
Business Address
-- JACOB LOUIS PETERSON
5667 S REDWOOD RD
TAYLORSVILLE, UT 84123-5433
Phone number: 801-979-1351
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Mailing Address
-- JACOB LOUIS PETERSON
6195 FOX POINTE CIR APT C1
PARK CITY, UT 84098-7597
Phone number: 208-629-9680
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