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 |