| NPI | 1174706808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE LYNNE MCCOLLUM President 720-535-6204 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CO 28393) |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2022-06-10 |