| NPI | 1710397633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN RYAN STOKES Owner/Manager 719-358-7422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CO 0006833) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2014-04-30 |