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 |