| NPI | 1861861155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE T. STEWART Billing Manager 801-756-9669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 343150-1204) |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2015-09-17 |