| NPI | 1720622616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANITA WIESCAMP Owner 719-510-0957 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2023-08-30 |