| NPI | 1093345886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATA RAMACHANDRAN CEO 970-298-2235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-01-21 |
| Last Update Date | 2020-01-21 |