| NPI | 1306031463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM ALBERT EVELAND President/Director 719-487-9075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: CO 8462) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2011-02-14 |