| NPI | 1881770592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORTLAND TY TIPPETS Administrator 435-673-8080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2023-06-21 |