| NPI | 1801297478 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA A KOPPIN Owner 719-251-5222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CO 0011162) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2014-09-15 |