Provider First Line Business Practice Location Address: 
1055 CLERMONT STREET (119)
    Provider Second Line Business Practice Location Address: 
DENVER VA MEDICAL CENTER- ECHCS
    Provider Business Practice Location Address City Name: 
DENVER
    Provider Business Practice Location Address State Name: 
CO
    Provider Business Practice Location Address Postal Code: 
80220
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
303-399-8020
    Provider Business Practice Location Address Fax Number: 
303-393-4624
    Provider Enumeration Date: 
08/06/2014