| NPI | 1477924728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT WHIRL Owner 719-452-9808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CO NLC.0013119) |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2015-10-13 |