| NPI | 1053604157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLEEN FULLER President 801-652-2720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 200419-2501) |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2011-07-25 |