| NPI | 1932571015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWEN MARIE HURD Ower 435-229-9177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 7027534-3501) |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2015-10-28 |