| NPI | 1275857203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA JEAN VILLARREAL Manager 719-486-8285 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CO DH-905202) |
| Enumeration Date | 2010-03-19 |
| Last Update Date | 2010-03-19 |