Provider First Line Business Practice Location Address:
255 N. 30TH ST
Provider Second Line Business Practice Location Address:
ADULT & GERIATRIC MEDICAL SPECIALTIES
Provider Business Practice Location Address City Name:
LARAMIE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-742-6319
Provider Business Practice Location Address Fax Number:
307-742-6346
Provider Enumeration Date:
08/02/2005