| NPI | 1932507613 |
|---|---|
| Doing Business As | SOUTH LOGAN FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | NATHANIEL J MOORE Owner 303-733-3764 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CO 35543) |
| Enumeration Date | 2014-12-12 |
| Last Update Date | 2015-11-06 |