| NPI | 1477312015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC FILLMORE Owner 801-824-1541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2024-03-18 |
| Last Update Date | 2024-03-18 |