| NPI | 1871027417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANELL BURGON Credentialor 801-701-6504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: UT 7678772-1205) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2017-04-19 |