| 124 South Fairfield Llc | |
|
124 S Fairfield Rd Ste B Layton UT 84041-7106 | |
| (801) 719-2316 | |
| (801) 336-4873 |
| Full Name | 124 South Fairfield Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 124 S Fairfield Rd Ste B, Layton, Utah |
| Authorized Official Name and Position | Eric Mansell (MANAGER) |
| Authorized Official Contact | 8017912202 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 124 South Fairfield Llc 124 S Fairfield Rd Ste B Layton UT 84041-7106 Ph: (801) 719-2316 | 124 South Fairfield Llc 124 S Fairfield Rd Ste B Layton UT 84041-7106 Ph: (801) 719-2316 |
| NPI Number | 1578100186 |
|---|---|
| Provider Enumeration Date | 12/02/2019 |
| Last Update Date | 09/11/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578100186 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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