| NPI | 1831421429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER MICHELLE CHILD Administrator 801-268-1715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2010-02-05 |
| Last Update Date | 2010-02-05 |