| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 2930 Pearl St, Boulder, Colorado |
| Authorized Official Name and Position | William Wright (SECRETARY) |
| Authorized Official Contact | 6155775893 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5500 Maryland Way Ste 120 Brentwood TN 37027-4993 Ph: () - | 2930 Pearl St Boulder CO 80301 Ph: (888) 926-9385 |
| NPI Number | 1902673510 |
|---|---|
| Provider Enumeration Date | 12/05/2023 |
| Last Update Date | 04/17/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902673510 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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