Provider First Line Business Practice Location Address:
BUILDING 1041, TMC 9
Provider Second Line Business Practice Location Address:
EVANS ARMY COMMUNITY HOSPITAL
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-524-2003
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2005