| NPI | 1528128899 |
|---|---|
| Doing Business As | FOURTH STREET CLINIC |
| Entity Type | Organization |
| Authorized Contact | JANIDA EMERSON CEO 801-364-0058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-12-09 |
| Last Update Date | 2020-11-24 |