| NPI | 1588968374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD LEE WALLINGFORD Manager 970-249-1238 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 47328) |
| Enumeration Date | 2011-01-07 |
| Last Update Date | 2011-01-07 |