| NPI | 1144589425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD MOORE CEO 719-543-8718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CO 180635) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2013-09-06 |