| NPI | 1588210934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN VIDLOCK GRANLEY Owner/Physician 720-592-0112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2019-10-16 |