| NPI | 1073716494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAQUEL L MARTIN Admin 303-751-7077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CO 251e00000x) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2016-05-12 |