| NPI | 1578881918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON A HALES Owner 801-783-9265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 75934640162) |
| Enumeration Date | 2010-05-10 |
| Last Update Date | 2014-03-03 |