Provider First Line Business Practice Location Address: 
1633 MEDICAL CENTER POINT
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
COLORADO SPRINGS
    Provider Business Practice Location Address State Name: 
CO
    Provider Business Practice Location Address Postal Code: 
80907
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
719-228-0400
    Provider Business Practice Location Address Fax Number: 
719-667-4155
    Provider Enumeration Date: 
03/03/2006