| NPI | 1982669982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY MARIE KEYES Health Program Representative Bille 801-626-3353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP0905X Clinic/Center Public Health, State or Local (Licence: UT 1610961205) |
| Additional Taxonomies | 261QP0905X Clinic/Center Public Health, State or Local (Licence: UT 105991-1206) |
| 261QP0905X Clinic/Center Public Health, State or Local (Licence: UT 285456-4405) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2012-05-18 |