| NPI | 1922279736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY WANN Owner 801-523-3898 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: UT 5636714-1202) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2008-03-19 |