| NPI | 1720485980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATTI BOUGHTON Practice Manager 719-955-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CO 1184635914) |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2021-08-25 |