Individual
KEITH DAVID LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3239 INDEPENDENCE RD, CANON CITY, CO 81212-9380
(719) 275-7650
Mailing address
3239 INDEPENDENCE RD, CANON CITY, CO 81212-9380
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/15/2017
Last updated
09/15/2017
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