Provider First Line Business Practice Location Address:
PE CLINIC BLDG 1150
Provider Second Line Business Practice Location Address:
USA MEDDAC, EACH
Provider Business Practice Location Address City Name:
FT. CARSON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80913-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-524-5745
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2006