Organization
PRIMARY CHILDRENS MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM THOMAS KUSHNER SUDC (SUBSTANCE ABUSE COUNSELOR)
(801) 313-7858
Entity
Organization
Contact information
Practice address
5770 SOUTH 1500 WEST, BUILDING A, SALT LAKE CITY, UT 84123
(801) 313-7800
Mailing address
5770 SOUTH 1500 WEST, BUILDING A, SALT LAKE CITY, UT 84123
(801) 313-7800
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
2743846006
UT
Other
Enumeration date
12/20/2012
Last updated
12/20/2012
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