Organization
ADVANCED INFANT FORMULAS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALLACE LAYNE SISLER (PARTNER)
(719) 201-6231
Entity
Organization
Contact information
Practice address
10 CIRCLE C RD, FOUNTAIN, CO 80817-3307
(719) 201-6231
(719) 392-4607
Mailing address
10 CIRCLE C RD, FOUNTAIN, CO 80817-3307
(719) 201-6231
(719) 392-4607
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Enumeration date
12/10/2007
Last updated
12/10/2007
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