| NPI | 1659504454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY BLANE CHILDERS Owner 719-579-0900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: CO CO30910) |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2009-08-26 |