| NPI | 1174114417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIELA R KENDALL Credentialing Specialist 970-928-1635 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-01-29 |
| Last Update Date | 2021-01-29 |