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1250 E 3900 S Ste 440 Salt Lake City UT 84124 | |
| (801) 869-4100 | |
| (801) 869-4119 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1250 E 3900 S Ste 440, Salt Lake City, Utah |
| Authorized Official Name and Position | Brian Liljenquist (MANAGING PARTNER) |
| Authorized Official Contact | 8018694100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1250 E 3900 S Ste 440 Salt Lake City UT 84124-1349 Ph: (801) 869-4100 | 1250 E 3900 S Ste 440 Salt Lake City UT 84124 Ph: (801) 869-4100 |
| NPI Number | 1174062376 |
|---|---|
| Provider Enumeration Date | 02/21/2017 |
| Last Update Date | 06/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174062376 | NPI | - | NPPES |
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