| NPI | 1295092674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRINITY L VERCIMAK Owner 801-419-1269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 701394-3501) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2012-04-23 |