| NPI | 1689467771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLOR GRAY-PERRY Facility Credentailing Specialist 970-494-9945 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2025-05-22 |
| Last Update Date | 2025-05-22 |