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 |