| NPI | 1588065684 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY GOMEZ Owner/Operator 435-503-6474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 81702783501) |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2014-09-08 |