| NPI | 1851149702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRI CHAMBERS Vice President Operations 719-314-3535 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2024-05-07 |
| Last Update Date | 2024-05-07 |