| NPI | 1952841819 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTINA GIAQUINTO Billing Manager 801-502-7808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: UT 96322409120) |
| Enumeration Date | 2017-02-26 |
| Last Update Date | 2020-12-23 |