| NPI | 1992170443 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIA BULLOCK Office Manager 435-797-1131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: UT 317131-1204) |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2015-12-09 |