| NPI | 1679059687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE RENEE NALLEY Office Manager 719-445-0383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: CO 32462) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2018-07-12 |