| NPI | 1851778245 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL ELIZABETH PETTY Lmt/Owner 970-213-8340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: CO MT.0011246) |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2015-05-05 |