| NPI | 1306010574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL R ODOM Administrator 801-233-8670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: UT 16640) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 16640) | |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2023-02-22 |