| NPI | 1033561717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIAN ESCALANTI Owner 801-599-3104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 8607093-3501) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2022-10-12 |