| NPI | 1952071219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP LEE DAVIS Chief Financial Officer 719-543-8718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2021-09-17 |