| NPI | 1790273704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRELL LEE SELLERS Medical Director 801-859-8092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: UT 293281-1205) |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: UT 311613-3102) |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2018-04-25 |