| NPI | 1669530192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDOLPH MAUL Chief Medical Officer 719-306-2821 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2400X Clinic/Center Prison Health (Licence: CO 391) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2025-06-24 |