Provider First Line Business Practice Location Address:
1000 E. UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
DEPT. 3375
Provider Business Practice Location Address City Name:
LARAMIE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82071-3375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-766-2550
Provider Business Practice Location Address Fax Number:
307-766-2953
Provider Enumeration Date:
06/02/2005