Provider First Line Business Practice Location Address: 
13001 E. 17TH PLACE
    Provider Second Line Business Practice Location Address: 
UNIVERSITY OF COLORADO SCHOOL OF MEDICINE GME
    Provider Business Practice Location Address City Name: 
AURORA
    Provider Business Practice Location Address State Name: 
CO
    Provider Business Practice Location Address Postal Code: 
80045-2581
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
303-724-7879
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/01/2015