Individual
LESLIE ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1925 M RD, FRUITA, CO 81521-9628
(970) 314-0669
Mailing address
1925 M RD, FRUITA, CO 81521-9628
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
PTA.0012295
CO
Other
Enumeration date
12/14/2015
Last updated
12/14/2015
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