Provider First Line Business Practice Location Address:
717 PINE STREET
Provider Second Line Business Practice Location Address:
REGIONAL HEALTH MEDICAL CLINIC
Provider Business Practice Location Address City Name:
UPTON
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82730-9901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-468-2302
Provider Business Practice Location Address Fax Number:
605-718-7082
Provider Enumeration Date:
05/20/2015