| NPI | 1700458981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATE BOGUE Credentialing 719-632-4455 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2021-07-23 |