| NPI | 1861887838 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELINDA DIAMOND Office Manager 801-254-1278 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: UT 140202-9922) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2015-04-06 |