Provider First Line Business Practice Location Address:
1008 MINNEGUA AVE
Provider Second Line Business Practice Location Address:
EMERGENCY ROOM
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-557-5656
Provider Business Practice Location Address Fax Number:
719-557-4715
Provider Enumeration Date:
10/07/2005