| NPI | 1750116638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANISHA WITTWER Owner/Office Admin 435-477-2583 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2024-09-04 |