| NPI | 1083162226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER M STARK Owner 801-948-0939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 8598755-6004) |
| Enumeration Date | 2016-09-16 |
| Last Update Date | 2016-09-16 |