| NPI | 1053179721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIESEL MADDOX Registered Dietitian Nutritionist 719-445-9573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Enumeration Date | 2024-03-07 |
| Last Update Date | 2024-03-07 |