| NPI | 1083097851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER COLLEEN CONOVER Owner 719-284-4708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CO 30505093) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2015-06-29 |