| NPI | 1144661273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI LEE BEASLEY Operation Manager 719-216-2054 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CO 6670) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2013-07-17 |