NPI | 1760847008 |
---|---|
Entity Type | Organization |
Authorized Contact | TABITHA ZAPPONE Owner 970-946-9939 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CO 0990376) |
Enumeration Date | 2015-12-30 |
Last Update Date | 2015-12-30 |