Individual
MS. DALE J MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2867 CENTRAL AVE, CANON CITY, CO 81212-9192
(719) 571-0515
Mailing address
28 CENTRAL AVE, CANON CITY, CO 81212
(719) 571-0515
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
140620303
CO
Other
Enumeration date
04/14/2023
Last updated
04/14/2023
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