| NPI | 1831120583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONDA J. BORREGO Office Manager 303-776-3937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CO 25327) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2023-03-07 |