| NPI | 1912030743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TATYANA I DATKHAEVA Owner Physician 720-540-7155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 45108) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2023-03-07 |