| NPI | 1255734117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDY JO KAISNER Chief Financial Officer 719-275-2351 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2024-05-10 |