| NPI | 1558549923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIANNA E GANTT Office Manager 303-649-1320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CO 42037) |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2012-02-07 |