NPI | 1871842674 |
---|---|
Entity Type | Organization |
Authorized Contact | COREY BERNHARDT Owner/Provider 970-461-3464 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CO 2919) |
Enumeration Date | 2012-09-07 |
Last Update Date | 2020-03-19 |