Provider First Line Business Practice Location Address:
1200 E ELIZABETH ST
Provider Second Line Business Practice Location Address:
FORT COLLINS YOUTH CLINIC
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80524-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-267-9510
Provider Business Practice Location Address Fax Number:
970-482-6938
Provider Enumeration Date:
07/01/2010