| NPI | 1477150282 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLEY FAGERBERG Vice President Finance 719-530-2213 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2020-10-05 |