NPI | 1508231218 |
---|---|
Entity Type | Organization |
Authorized Contact | RACHELLE MERCHANT Owner 719-663-0281 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CO 0007104) |
Enumeration Date | 2015-12-07 |
Last Update Date | 2017-01-10 |