| NPI | 1649524653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD MOORE CEO 719-543-8711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2012-11-19 |