| NPI | 1962536326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WAYNE BANKER President 719-275-8646 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CO 27050) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2016-01-05 |