Provider First Line Business Practice Location Address:
2100 BROADWAY
Provider Second Line Business Practice Location Address:
STOUT STREET CLINIC
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80205-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-293-2220
Provider Business Practice Location Address Fax Number:
303-293-3977
Provider Enumeration Date:
06/29/2006