| NPI | 1972783751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDITH FAY VISNACK Owner Sole Proprietor 719-276-0801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CO 4116) |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2008-09-17 |