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1060 E 100 S #400 Salt Lake City UT 84102-1501 | |
(801) 521-2640 | |
(801) 363-6407 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 1060 E 100 S, Salt Lake City, Utah |
Authorized Official Name and Position | Becky Sellers (PRACTICE ADMINISTRATOR) |
Authorized Official Contact | 8015268353 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1060 E 100 S #400 Salt Lake City UT 84102-1501 Ph: (801) 521-2640 | 1060 E 100 S #400 Salt Lake City UT 84102-1501 Ph: (801) 521-2640 |
NPI Number | 1275940611 |
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Provider Enumeration Date | 07/17/2014 |
Last Update Date | 07/17/2014 |
Identifier | Type | State | Issuer |
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1275940611 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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