| NPI | 1295804110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON M. TERWEDO President 801-622-5272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone (Licence: UT 6264391-8913) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2015-08-06 |