| 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 |