Organization
124 SOUTH FAIRFIELD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC MANSELL (MANAGER)
(801) 791-2202
Entity
Organization
Contact information
Practice address
124 S FAIRFIELD RD STE B, LAYTON, UT 84041-7106
(801) 719-2316
(801) 336-4873
Mailing address
124 S FAIRFIELD RD STE B, LAYTON, UT 84041-7106
(801) 719-2316
(801) 336-4873
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
12/02/2019
Last updated
09/11/2020
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