| NPI | 1639364847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY MCKENZIE Owner 801-201-8571 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 5153757-6004) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2008-06-17 |