| NPI | 1154675098 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC T HELLAND Manager 719-687-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CO 3577) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2012-10-30 |