| NPI | 1497014096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANTELLE PRATT Manager 801-327-9336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: UT 7112893-1204) |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2026-05-06 |