| NPI | 1275125981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARK STEVEN MCCOY President 970-761-2207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2021-02-04 |
| Last Update Date | 2021-02-04 |