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 |