Provider First Line Business Practice Location Address:
1000 E UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT 3414
Provider Business Practice Location Address City Name:
LARAMIE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82071-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-766-5052
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2011