| NPI | 1912267212 |
|---|---|
| Doing Business As | PACIFIC STATES CLINIC |
| Entity Type | Organization |
| Authorized Contact | LINDA C LECKMAN CEO Intermountain Medical Group 801-442-3974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8082012) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2012-05-21 |