Individual
BRYANT DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
21360 NORTH 1450 EAST, MORONI, UT 84646
(435) 445-5200
Mailing address
P.O. BOX 461, 21360 NORTH 1450 EAST, MORONI, UT 84646
(435) 445-5200
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
272503815
UT
Other
Enumeration date
06/05/2012
Last updated
06/05/2012
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