NPI | 1285168583 |
---|---|
Entity Type | Organization |
Authorized Contact | LYN SNOW Compliance Officer 303-866-7149 |
Organization Subpart ? | No |
Primary Taxonomy | 305S00000X Point of Service (Licence: CO 727) |
Additional Taxonomies | 305S00000X Point of Service (Licence: CO LPC0011949) |
305S00000X Point of Service (Licence: MN 302302) | |
Enumeration Date | 2017-04-13 |
Last Update Date | 2022-07-21 |