Organization
WESTERN STATES MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARY FAIRBOURN (PRESIDENT)
(801) 540-4564
Entity
Organization
Contact information
Practice address
448 E 5350 S STE B, WASHINGTON TERRACE, UT 84405-5415
(801) 540-4564
Mailing address
448 E 5350 S STE B, WASHINGTON TERRACE, UT 84405-5415
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Enumeration date
08/18/2009
Last updated
08/18/2009
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