Provider First Line Business Practice Location Address:
BLDG #1041 BARKLEY AVE
Provider Second Line Business Practice Location Address:
DIRAIMANDO MEDICAL CLINIC
Provider Business Practice Location Address City Name:
FORT CARSON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-524-2047
Provider Business Practice Location Address Fax Number:
719-524-3526
Provider Enumeration Date:
11/16/2006