| NPI | 1003159112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA LEABOW Office Manager 801-996-3547 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 20956) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2013-03-27 |