| NPI | 1356374300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRUDY L FOGG Practice Administator 719-539-3583 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 173000000X Legal Medicine |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2018-06-14 |