| NPI | 1033614334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER HICKERT Practice Administrator 970-249-2421 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2018-03-28 |