| NPI | 1760716658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M. BIRD Office Manager 801-657-0163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 4788890-3501) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2009-09-24 |