Individual
CHARLES CORNISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
420 E SOUTH TEMPLE, SUITE 420, SALT LAKE CITY, UT 84111
(801) 322-3222
Mailing address
420 E SOUTH TEMPLE STE 420, SALT LAKE CITY, UT 84111-1345
(801) 322-3222
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/23/2018
Last updated
02/23/2018
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