| NPI | 1225681166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK HAWTHORNE KEEP Owner 801-699-6977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease |
| Enumeration Date | 2019-07-19 |
| Last Update Date | 2019-12-30 |