| NPI | 1972245595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL DICKERSON Md 970-217-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2022-09-06 |