| NPI | 1194276105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN SPILLANE Chief Financial Officer 719-344-7135 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2023-03-06 |