| NPI | 1295093656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA JERILYN YOUNG Clinical Theripist 801-608-9325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: UT 179401-3501) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2012-04-23 |