| NPI | 1912368549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SHEA ROBERTS Owner/Operator 435-760-7078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: UT 8689112-4405) |
| Enumeration Date | 2016-03-09 |
| Last Update Date | 2016-03-09 |