| NPI | 1194251892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY PONCE Owner 801-361-5605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 98093180160) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2017-05-02 |