| NPI | 1619624137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY ANN IVY VP Of Clinical Operations 719-574-5562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics |
| Enumeration Date | 2022-03-04 |
| Last Update Date | 2022-03-04 |