Individual
LARS ULISSEY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
7321 11TH ST, BLDG 569, HILL AFB, UT 84056-5012
(801) 777-4710
Mailing address
5914 HIGHLAND DR, MORGAN, UT 84050-9758
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A81520
CA
Other
Enumeration date
10/17/2005
Last updated
07/08/2007
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