Provider First Line Business Practice Location Address:
HIGHWAY 285 AND HIGHWAY 24
Provider Second Line Business Practice Location Address:
BUENA VISTA CORRECTIONAL COMPLEX MEDICAL DEPT
Provider Business Practice Location Address City Name:
BUENA VISTA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-395-7233
Provider Business Practice Location Address Fax Number:
719-395-7235
Provider Enumeration Date:
12/01/2006