| NPI | 1669871265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESTRIA BENNIS Office Manager 303-357-4040 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0004017) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2014-08-19 |