| NPI | 1407059330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEL COHEN Executive Director 719-475-2227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NM MD20040037) |
| Additional Taxonomies | 174400000X Specialist (Licence: NM MD20060528) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2020-08-22 |