Organization
BOUNTIFUL DIABETES CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALBERT BROWN (OWNER)
(801) 294-0191
Entity
Organization
Contact information
Practice address
440 MEDICAL DR., BOUNTIFUL, UT 84010
(801) 294-0191
Mailing address
1560 SOUTH RENAISSANCE TOWN DRIVE #250, BOUNTIFUL, UT 84010
(801) 294-0191
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
200836457
UT
Other
Enumeration date
12/24/2008
Last updated
12/24/2008
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