| NPI | 1952661647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNA ZAMPIELLO Owner 970-275-4334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA NT60200162) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2012-05-29 |