Individual
MRS. CONSTANCE KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1225 FORT UNION BLVD, 200, MIDVALE, UT 84047-1889
(801) 466-3102
Mailing address
6546 S 1580 E, SALT LAKE CITY, UT 84121-2517
(801) 272-0604
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
104569-1209
UT
Other
Enumeration date
04/09/2007
Last updated
07/08/2007
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