Acupuncture for Women's Health
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Some of the Women’s Health Conditions We Treat with Acupuncture
The Science Behind Acupuncture for Women’s Health Issues
Revealing the Central Mechanism of Acupuncture for Primary Dysmenorrhea Based on Neuroimaging: A Narrative Review
This research published in Pain Research and Management examined the effects of acupuncture on dysmenorrhea, which is pain during menstruation. The study looked at several previous research papers and found that acupuncture can help relieve pain by influencing the brain’s response to pain.
The researchers analyzed 11 randomized controlled trials (RCTs) and 14 non-randomized studies. They found that the most common acupuncture point used to treat dysmenorrhea was the Sanyinjiao point (SP6). Other acupuncture points were also explored, such as the Guanyuan point (RN4) and the Zusanli point (ST36). Most studies used only one acupuncture point for treatment.
To measure pain levels in women with dysmenorrhea, various scales were used, such as the Visual Analog Scale (VAS), the numerical pain intensity rating (NRS), and the McGill Pain Questionnaire (MPQ). Some studies also assessed patient symptoms and psychological status using different scales.
The researchers found that acupuncture can cause changes in the brain’s response to pain. The study identified several brain areas that were affected by acupuncture treatment for dysmenorrhea. These areas are involved in pain processing, emotional responses to pain, and cognitive functions related to pain.
The research suggests that acupuncture may treat dysmenorrhea by activating the nociceptive modulation system, the part of the nervous system that regulates our response to pain, and the cognitive-related limbic system, a collection of brain structures that play a significant role in our emotions, learning, and memory.
Acupuncture’s central mechanism appears to involve alterations in brain function and changes in different regional networks. The high-frequency brain areas altered during acupuncture treatment for dysmenorrhea include the anterior cingulate gyrus, hippocampus, thalamus, precuneus, insula, precentral gyrus, middle frontal gyrus, postcentral gyrus, middle temporal gyrus, putamen, and cerebellum. These areas are mainly distributed in the pain matrix, default mode network (DMN), salience network, and limbic system.
Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilization
This research published in the British Medical Journal analyzed the effectiveness of acupuncture as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilization (IVF). The study included seven randomized controlled trials with a total of 1,366 participants from four different Western countries. The women involved in these trials represented a diverse group, with various infertility diagnoses, ages, durations of infertility, and numbers of previous treatment cycles.
In all trials, the acupuncture protocol was specifically designed to improve pregnancy rates. Acupuncture sessions were performed immediately before or immediately after the embryo transfer, and all trials used a fixed selection of acupuncture points for all patients. Most trials supplemented body acupuncture with ear acupuncture, and the acupuncture sessions lasted 25-30 minutes.
The results demonstrated that combining acupuncture with embryo transfer led to significant improvements in clinical pregnancy, ongoing pregnancy, and live birth rates. Specifically, acupuncture increased the odds of clinical pregnancy by 65%, ongoing pregnancy by 87%, and live birth by 91%. In absolute terms, this means that for every 10 women treated with acupuncture, one additional woman would achieve clinical pregnancy, which is considered a clinically relevant benefit.
However, a subgroup analysis of the trials with higher baseline pregnancy rates suggested a smaller, non-significant benefit of acupuncture. This finding indicates that in IVF settings with already high baseline pregnancy rates, the relative added value of acupuncture may be reduced, but this requires further research.
Regarding safety and cost-effectiveness, acupuncture is generally considered safe, with serious adverse events being rare. It has been shown to be safe during labor and pregnancy, and no safety concerns were detected in a trial examining the effects of acupuncture during early pregnancy on later complications and perinatal outcomes. IVF is an expensive procedure, so if acupuncture can increase the likelihood of a successful IVF cycle, it may reduce the need for additional cycles, decreasing overall costs. Considering the relatively low cost of acupuncture compared to IVF, even a small increase in success rates could make acupuncture a cost-effective adjuvant treatment.
Acupuncture for pain in endometriosis
A study published in the Cochrane Library was conducted to assess the effectiveness and safety of acupuncture in treating endometriosis pain. Out of 24 studies that were initially identified, only one met all the necessary criteria for inclusion in the analysis. This trial included 67 participants who had laparoscopically confirmed endometriosis.
The results showed that the acupuncture group experienced a significant reduction in pain scores, with an average decrease of 4.81 points on a 15-point scale. Furthermore, the total effectiveness rate for the acupuncture group was 91.9%, compared to 60% for the Chinese herbal medicine group.
In particular, acupuncture showed significant benefits in reducing pain for cases of severe dysmenorrhea (painful periods). While both acupuncture and Chinese herbal medicine were effective in treating mild to moderate dysmenorrhea, acupuncture proved to be more successful in managing severe cases.
Efficacy and safety of traditional Chinese medicine on treating oligomenorrhea (irregular and inconsistent periods)
In this research published in the Annals of Palliative Medicine, 6,703 articles were initially identified, and after a series of evaluations, 26 randomized controlled trials (RCTs) were included in the systematic review (SR). The studies focused on the effects of Traditional Chinese Medicine (TCM) combined with biomedicine (BM) in treating oligomenorrhea, a condition characterized by infrequent menstrual periods.
The participants were aged between 16 and 47 years, and treatment duration varied from 4 weeks to 4 menstrual cycles. The studies were conducted in China and were published in Chinese. The results demonstrated that TCM combined with BM was more effective in treating oligomenorrhea compared to BM alone. Some of the key findings include:
- Increase in menstrual blood volume: TCM treatments plus BM showed a significant effect in increasing menstrual blood volume. In a subgroup analysis, TCM combined with different BM regimens also showed increased menstrual blood volume.
- Prolongation of menstrual period: TCM plus BM showed statistically significant results in prolonging the menstrual period that terminated prematurely.
- Adverse events (AEs): No statistical significance was found in the frequency of AEs between the groups of TCM + BM and BM alone, suggesting that TCM treatment might have a satisfactory safety profile.
- Effectiveness rate: TCM treatments plus BM showed significant benefits in enhancing effectiveness rates in oligomenorrhea patients compared with BM alone.
- Endometrial thickness: TCM plus BM showed a significant increase in endometrial thickness compared to BM alone.
- Hormone levels: TCM plus BM led to a mean increase in estradiol (E2) and progesterone (P) levels, but no significant differences were found in follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels.
However, the study also highlighted that the overall quality of evidence was “low” or “very low” according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method.
The mechanisms of TCM in treating oligomenorrhea are not fully understood. Some proposed mechanisms include phytoestrogen-like effects, anti-inflammatory effects, and improvement of blood supply. Some TCM herbs have also been found to restore follicles in the ovaries, thicken the uterine wall, increase endometrium glands, and improve blood hemorheology.
Trajectories of Response to Acupuncture for Menopausal Vasomotor Symptoms
This study published in Menopause: The Journal of the North American Menopause Society examined the effects of acupuncture on menopausal vasomotor symptoms (VMS), such as hot flashes, in 209 perimenopausal and postmenopausal women aged 45-60 years. The women were randomly assigned to receive up to 20 acupuncture treatments within six months or join a waitlist control group. The main goal was to see how much the frequency of VMS changed from the start of the study.
The results showed four different patterns of change in VMS frequency after eight weeks of acupuncture. About 12% of the women had an 85% reduction in VMS, nearly half (47%) experienced a 47% reduction, around 37% had only a 9.6% reduction, and a very small group (4.1%) saw a 100% increase in VMS. In the waitlist control group, almost 80% of women reported a 10% decrease in VMS frequency after eight weeks.
Overall, 59% of women who received acupuncture had at least a 40% reduction in VMS frequency over the first eight weeks, while 11% achieved an 80% reduction after just a few weeks of treatment. However, 41% of women had little to no reduction in VMS frequency by the end of the eight-week period. The study did not find clear predictors of how well acupuncture would work for each woman, but it did suggest that women with a certain type of traditional Chinese medicine (TCM) diagnosis other than kidney yin deficiency might experience a particularly strong response to acupuncture.
In conclusion, this research suggests that most women may see a significant reduction in menopause-related VMS frequency after eight weeks of acupuncture treatment. Some women might have an especially rapid and strong response to acupuncture, but the study did not identify clear predictors of this response.
Acupuncture Treatment of Dysmenorrhea (painful periods) Resistant to Conventional Medical Treatment
This research published in the journal Evidence Based Complementary and Alternative Medicine evaluated the effects of acupuncture on pain related to NSAID-resistant dysmenorrhea in 15 patients. Pain was measured using the Visual Analogue Scale (VAS) at different time points: baseline, mid-treatment, end of treatment, and 3 and 6 months after treatment. A significant reduction in pain and NSAID use was observed in 87% of patients (13 out of 15). Pain intensity, measured by average VAS, was reduced by 64% at mid-treatment, 72% at the end of treatment, 60% at 3 months post-treatment, and 53% at 6 months post-treatment compared to baseline. Greater pain reduction was observed in primary dysmenorrhea compared to secondary dysmenorrhea.
The average pain duration at baseline (2.6 days) was significantly reduced at all time points, with reductions of 62% at mid-treatment, 69% at the end of treatment, and 54% at both 3 and 6 months post-treatment. Average NSAID use was also significantly reduced at all time points, with reductions of 63%, 74%, 58%, and 58% at mid-treatment, end of treatment, and 3 and 6 months post-treatment, respectively. In fact, seven patients ceased NSAID use completely and remained asymptomatic 6 months after treatment.
These findings suggest that acupuncture may be an effective treatment option for dysmenorrhea-related pain, particularly for individuals who cannot or do not want to use NSAIDs or oral contraceptives.
Effectiveness of acupuncture in polycystic ovary syndrome (PCOS)
This systematic review and meta-analysis published in the journal Medicine, evaluated the effectiveness of acupuncture in reproductive-age females with polycystic ovary syndrome (PCOS). Twenty-two studies with 2,315 participants were included in the analysis. The primary outcomes were the rate of live birth, pregnancy, and ovulation, while secondary outcomes included recovery of menstrual period and hormone levels.
The results showed that acupuncture promoted the recovery of menstrual periods and significantly decreased luteinizing hormone (LH) and testosterone levels in the acupuncture group. However, no significant differences were observed in the rates of live birth, pregnancy, ovulation, and LH/follicle-stimulating hormone (FSH) ratio. The authors concluded that there was insufficient evidence to support the claim that acupuncture could promote live birth, pregnancy, and ovulation in patients with PCOS. However, acupuncture did show potential in promoting the recovery of menstrual cycles and regulating LH and testosterone levels in PCOS patients.
Japanese-Style Acupuncture for Endometriosis-Related Pelvic Pain
This randomized, sham-controlled trial published in The Journal of Pediatric and Adolescent Gynecology aimed to assess the feasibility of Japanese-style acupuncture as an adjunct therapy for reducing chronic pelvic pain and improving health-related quality of life (HRQOL) in adolescents with endometriosis. The study included 18 young women (aged 13-22) with laparoscopically-diagnosed endometriosis-related chronic pelvic pain. Participants received either Japanese-style acupuncture or sham acupuncture over 16 treatments in 8 weeks.
The results showed that participants in the active acupuncture group experienced a significant reduction in pain (62%) after 4 weeks, compared to the control group. This pain reduction persisted through a 6-month assessment; however, after 4 weeks, the differences between the active and control groups decreased and were no longer statistically significant. HRQOL measures indicated greater improvements in the active acupuncture group compared to the control group, but most of these trends were not statistically significant. No serious adverse events were reported.
The study concluded that Japanese-style acupuncture may be an effective, safe, and well-tolerated adjunct therapy for endometriosis-related pelvic pain in adolescents. A more definitive trial evaluating Japanese-style acupuncture in this population is both feasible and warranted.
Note on Sham Acupuncture
In regard to the study findings with sham acupuncture being just as effective as traditional acupuncture, it means that an acupuncturist can choose the “incorrect” points or miss the traditional points and still get significant relief for patients with pelvic pain
Acupuncture for Premenstrual Syndrome (PMS) at Different Intervention Time
This systematic review published in Evidence Based Complementary and Alternative Medicine found that acupuncture is more effective in treating premenstrual syndrome (PMS) than sham acupuncture and related medications. Acupuncture is believed to work by stimulating the central nervous system, promoting the release of specific neuropeptides, and regulating autonomic nervous system activity.
The intervention time for acupuncture treatment in the studies varied, with no significant differences found among different intervention times. The most frequently used acupuncture points in treating PMS were SP6, LR3, and RN4. SP6 is considered key for treating gynecological diseases and can regulate abnormal nerve activity and hormonal balance.
Another research review published in the British Journal of Obstetrics and Gynecology aimed to evaluate the current evidence for acupuncture as a treatment for premenstrual syndrome (PMS). Ten randomized controlled trials (RCTs) were included in the review. The pooled results showed that acupuncture is superior to all controls, with significantly improved symptoms compared to sham acupuncture. A meta-analysis comparing the effects of acupuncture with different doses of progestin and/or anxiolytics also supported the use of acupuncture. No evidence of harm resulting from acupuncture was found.
Acupuncture and Traditional Chinese Medicine Herbal Formulas for Uterine Fibroids
This study published in the Journal of Ethnopharmacology aimed to explore the pharmacological mechanism of Guizhi Fuling Capsule (GFC), a traditional Chinese medicine formula known to be effective in treating uterine fibroids (UFs). Mediator complex subunit 12 (Med12) mutations are closely related to UFs in 85% of cases, and the Wnt/β-Catenin signaling pathway plays a crucial role in the occurrence and development of UFs. The researchers silenced Med12 in uterine fibroid cells and established a rat model of UFs. They divided rats into six groups, treating some with different doses of GFC, others with mifepristone, and the remaining with normal saline.
The results showed that the Wnt/β-Catenin signaling pathway was inhibited after the Med12 gene was knocked out in uterine fibroid cells. GFC-containing serum induced cell apoptosis, inhibited cell proliferation, and reduced the expression of related genes. The weight, endometrial thickness, and pathological structure of the uterus in the GFC-treated groups improved significantly compared to the model control group. The expression of genes related to the Wnt/β-Catenin pathway decreased with increased GFC dosage.
In conclusion, GFC inhibited the growth of UFs, which was directly associated with Med12 modulated Wnt/β-Catenin signaling pathway. This study provides a new perspective for understanding the therapeutic mechanism of UFs.
This study published in Medical Acupuncture aimed to evaluate the feasibility of conducting clinical trials on treating uterine fibroids (UFs) and related symptoms using a 7-point Tung’s acupuncture protocol. Nine participants were recruited into two treatment groups, one receiving acupuncture for 6 weeks and the other for 12 weeks. Ultrasound examinations were performed before and after treatment to assess uterine size, number of fibroids, and volume. A Symptom Survey Questionnaire was also given to participants at each acupuncture session.
All nine participants completed the program without any adverse reactions or complaints. Eight participants reported improvements in their symptoms after 6 weeks of acupuncture, with significant reductions in 10 out of 14 surveyed symptoms. The 12-week group showed a higher percentage of symptom reduction compared to the 6-week group, with 9 out of 14 symptoms completely eliminated after 12 weeks of treatment. However, changes in uterine size and fibroid volume could not be determined due to technical issues with the ultrasound examinations.
The study concluded that it is possible to conduct larger clinical trials for treating UFs with acupuncture, and that acupuncture might help reduce UF-related symptoms. Further research with larger samples, negative control groups, and long-term follow-up is needed to confirm these findings.
The Benefits of Acupuncture for Women’s Health
Acupuncture can help decrease the frequency and severity of the negative symptoms of many types of women’s health issues by targeting specific points that are connected to these conditions.
Natural and pharmaceutical free relief
Acupuncture is a non-pharmacological treatment option for many sorts of women’s health problems, eliminating the need for drugs and their associated negative side effects.
Provides long-term relief
Many patients and research studies find that acupuncture provides long-lasting relief from a variety of women’s health problems, reducing the need for ongoing treatments or medications.
Improved Mental Health & Sleep
Acupuncture can help relieve stress, reduce muscle tension, and improve sleep all of which are common symptoms that go along side many women’s health conditions.
How we Achieve 0ur Results
We understand that each person’s health issues are unique, we provide tailored care that meets your needs and goals. Our acupuncture treatments address both the symptoms and their underlying reasons to provide lasting relief and wellness.
Having a robust support system is crucial during your health journey. Throughout your treatment, our dedicated team is available to assist, answer questions, and address your concerns. We offer a kind and supportive environment in which to treat your health problems.
When it comes to addressing women’s health issues, we understand that certain patients may be suffering from food-related triggers or nutrient deficiencies. We will strive to assist you to eliminate any food triggers, as well as offer suggestions for nutrient-dense meals and pre and probiotic foods if necessary.
We know that lifestyle choices can have an impact on a variety of health issues. We help our patients discover and change lifestyle choices that may be triggering them. Mindfulness exercises, deep breathing, a consistent sleep schedule, and moderate physical activity may be advised.
At The Subtle Point, we understand that trying something new, especially when it comes to your health, can be a big decision. That’s why we’re pleased to offer free consultations at our Denver clinic for new clients interested in exploring the benefits of acupuncture and our other services.
During your free consultation, you can expect:
- A welcoming and judgment-free environment: We believe in providing a safe and supportive space for you to explore your options and make informed decisions about your health and well-being.
- One-on-one discussion: Our experienced practitioners will sit down with you to discuss your health concerns, answer any questions you may have, and help you determine if acupuncture is the right fit for your needs.
- Personalized treatment plan: If you decide to move forward with treatment, we’ll work together to create a customized plan tailored to your specific goals and concerns.
Taking the first step towards better health has never been easier or more accessible. Schedule your free consultation today by calling us at (720)285-6251 or booking online. Discover how The Subtle Point can help you unlock your body’s natural healing potential and guide you on your path to wellness.
What to Expect from Your First Treatment For Women’s Health Issues
Comprehensive Health Assessment
Our skilled practitioners will discuss your medical history, lifestyle, and concerns during your initial consultation to set your health goals. Your practitioner will evaluate your pulse, tongue, and ask numerous questions to determine any imbalances. Based on the findings of this evaluation, they will make a diagnosis and suggest a specific treatment plan.
During your acupuncture session, you will lie back comfortably on a treatment table while the practitioner inserts thin, sterilized needles into specific points on your body. The needles may create a tiny pinch as they are inserted, but the operation is normally painless. We will leave you to relax for 20-30 minutes after the needles have been inserted.
Aftercare and Follow-ups
Your practitioner will provide you lifestyle, dietary, and at-home care assignments after your treatment. Based on your needs, they will also discuss the frequency of follow-up appointments. Your needs, treatment goals, and response to treatment will decide the frequency of your follow-up appointments.
Our Reviews and Patient Testimonials
Michael knows his craft extremely well and is gifted at creating a healing space and experience that is comfortable and safe. He asks pointed questions to gain a better understanding of what stressors are impacting your body. I went in for cupping with CBD oil and left with a better understanding of
The owner is knowledgeable, caring, and accommodating. Clean, quiet and well organized office
Michael was PERFECT! He asked a lot of questions about my pain and went to work on relieving it. The pain in my side that would wake me up every night for years has been gone for 4 days now thanks to the acupuncture. I also received such an amazing neck and head rub it made my toes tingle!
Best experience I’ve ever had! Thank you!
I’m really glad I did this deal. All of the mental stress and exhaustion was gone by the time I got home from doing the acupuncture. My organs felt much more clearer from the acupuncture as well. The cupping really helped resolve a lot of my problem areas such as lower back pain
Michael was very knowledgeable and professional. It was a very nice experience. We discussed regarding healthy food I am eating He recommended some food to try to help me with my weight and stress. It was a very productive discussion about stress, food.
So personable and professional. He really listened to my concerns and issues then worked with me to develop a plan for relief. I am feeling so much better after my visits.
This is part of my getting services while Black series. I booked my appointment through Groupon. I was on the search for acupuncture and cupping. I 100% recommend coming to see Michael. As soon as we sat down Michael made me feel comfortable.
I had a great experience at The Subtle Point. After my visit, I felt listened to and hopeful that my foot pain could improve. Highly recommend The Subtle Point for Accupuncture!!!
Michael was very knowledgeable regarding acupuncture as this was my first time! Answered any questions or concerns I had. Thorough consultation prior to treatment! Clean, friendly office. Would highly recommend!
Michael was amazing! I received such care and understanding from the time I walked through the door. He asked all the right questions and made sure I was comfortable and knew what he was doing the whole time. Thank you so much Michael. I will be back
Intuitive and interested in knowing what is causing the problem and treats accordingly after getting to the root of your issues. Genuine and informative. I will be back and highly recommend.
Mike was absolutely amazing! He has great bedside manner and a great energy overall. He walked me through the process of everything and was great about making sure all my questions were answered. I went in with a rib pain on the back side of my rib cage. I left feeling SO much better
Mike is great!! Great service overall. I was having severe back pain and the Groupon had acupuncture, message guns, and cupping. I would highly recommend.
Excellent. My pain is immediately gone and didn’t realize how tense I was until I started moving and practically melted off the bed. Mike is very knowledgeable and explained everything to me. I didn’t even feel the needles from acupuncture.
Mike was great! He explained everything and was very communicative about acupuncture and cupping processes. He also provided lots of recommendations continued treatments and for pain/stress management. This was a great experience and I plan to return!
Over 290 5 Star Reviews
40 Five Star Reviews
Great experience. I do the 90 minute acupuncture and cupping combo. I usually go in with moderate to severe back pain and leave pain free. Mike does a great job explaining things…
– Emily L.
247 Five Star Reviews
Wonderful experience! Mike was amazing and truly cares about your health and healing. He offered lots of time to ask questions and discuss my issues. He also offered great sugges…
8 Five Star Reviews
Michael is very knowledgeable..I’m a very hardworking Hair Stylist and since he has been treating my aching back I feel 20years Younger and so much out of pain.
– Nikki Sanchez
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Initial Acupuncture Treatment
The initial exam and treatment lasts approximately 60 minutes. During this visit we will go through your health history, conduct a physical exam consisting of tongue and pulse diagnosis, and examination of any and all areas of pain or discomfort. After the exam we will move into the treatment phase. The initial treatment is meant to address your presenting symptoms, promote relaxation, and lower your stress. Follow-up treatments are aimed to address the underlying root of your problem.
Half Hour Acupuncture
Our half hour acupuncture will be tailored to your specific area of complaint to work at the root of the problem. Because of the short duration of these treatments, cupping and tuina can not be incorporated.
During your hour long follow-up we will tailor your acupuncture treatment to your specific area of complaint. We will work on treating the root of the complaint as well as any accompanying symptoms. These sessions can also include the following modalities: cupping, tuina, herbal or supplement recommendations, diet tips, photobiomodulation, electrical stimulation, or lifestyle advice.
Frequently Asked Questions
Does acupuncture Hurt?
Acupuncture uses needles that are significantly smaller than any syringe that a doctor would normally use. The sensation has been said to be comparable to a bug bite or a pinch, but often most people do not feel anything at all. Certain points are very tender to needle, and we try to avoid these points unless they are absolutely necessary. If you are sensitive to the needles we will adjust your treatment accordingly so that we can help you achieve your health goals in alignment with your comfort.
How Many treatments does it take?
The number of treatments that it takes to treat any given condition is based on a great number of factors. Some of these factors can include: how long you have had said condition, age, dietary and lifestyle factors, willingness to perform self care at home, etc. It would also be safe to say that this medicine isn’t magic and no condition will be fully resolved after one treatment. However with that being said, many patients often leave the office with less pain than they started with and feeling more relaxed.
How long is each treatment?
At The Subtle Point, we offer a variety of services that can run from 5 minutes to as long as an hour. Initial appointments, however, are one hour long. During that appointment we will go over your health intake form, go over the estimated amount of treatments that will get you to your optimal health, go over the treatment methods that will be utilized, herbal medicine, dietary and lifestyle advice, and more.
Do i need to disrobe for my treatment?
For the most part, no you don’t. I typically try and utilize points below the elbows and knees, sometimes around the belly, and sometimes on the back. Because of this I highly recommend that you come in wearing loose, comfortable clothing to allow easy access to these areas.
How can I schedule an appointment?
To schedule an appointment you can call, send us an email, or book online by clicking on the “Book Now” button in the upper right portion of the screen.
What forms of payment do you accept?
We accept cash, check, and credit card (Visa, Mastercard, American Express, and Discover).
Do you accept insurance?
At this time I am not accepting insurance, but I can give you an invoice/superbill to give to your insurance company for reimbursement.
3600 South Beeler Street Suite 150 Denver, CO 80237
Make an Appointment
To make an appointment please click the link below or call (720) 285-6251
Monday, Wednesday, Friday: 11am - 8pm Saturday: 10am - 7pm