| NPI | 1356305114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE BARNES Authorized Official 719-634-1994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Additional Taxonomies | 208800000X Urology |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2024-08-20 |