| NPI | 1346495298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY COSTLEY Chief Operating Office 801-261-5790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: UT 5863251-8913) |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2008-11-19 |