| NPI | 1245504265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD D. JENSEN Clinic Director 801-904-2198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone (Licence: UT 18860) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: UT 18860) |
| Enumeration Date | 2012-03-08 |
| Last Update Date | 2012-03-08 |