| NPI | 1104001379 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA JOAN WEAVER-OSTERHOLTZ Owner 719-676-3728 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: CO 40134) |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2009-10-15 |