| NPI | 1770039109 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY M MARTINEAU Sole Owner 801-425-4187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 8394257-3501) |
| Enumeration Date | 2016-08-26 |
| Last Update Date | 2016-08-26 |