| NPI | 1891176939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY S STOREY Medical Office Manager 801-475-5210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 53377011205) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2025-01-10 |