Organization
TKO AESTHESIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK BRADLEY WATERS APRN-CRNA (MANAGER)
(435) 773-5585
Entity
Organization
Contact information
Practice address
754 S MAIN ST STE 3&4, SAINT GEORGE, UT 84770-5504
(435) 628-2671
Mailing address
1401 N 2200 W, SAINT GEORGE, UT 84770-5756
(435) 773-5585
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
04/05/2021
Last updated
04/05/2021
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