| NPI | 1760805543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL L VOLLMER Owner 435-730-0731 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: ID LSW-28623) |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2014-01-29 |