| NPI | 1467830919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY M MARTINEAU Social Worker 801-425-4187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: UT 8394257-3501) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2015-05-15 |