NPI | 1770997637 |
---|---|
Entity Type | Organization |
Authorized Contact | BRANDON CAMPBELL Owner 720-877-1390 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CO 201813) |
Enumeration Date | 2014-06-18 |
Last Update Date | 2014-06-18 |