| NPI | 1861587081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | D.J. BALLINGHAM Medical Director 435-946-3660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: UT 81-0587644) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |