| NPI | 1952589236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLA REVILLA Billing Manager 719-229-3849 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD070945L) |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2024-07-03 |