| NPI | 1609542596 |
|---|---|
| Doing Business As | 48TH AVENUE |
| Entity Type | Organization |
| Authorized Contact | PETE J STOLLER CFO 303-312-9606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2021-08-19 |