| NPI | 1194266809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW CARSON PONDER Co Owner 844-355-7673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: CO 0054605) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2017-11-08 |