Provider First Line Business Practice Location Address:
USA MEDDAC, EVANS ARMY COMMUNITY HOSPITAL
Provider Second Line Business Practice Location Address:
1650 COCHREAN CIRCLE, ATTN: CREDENTIALS OFFICE
Provider Business Practice Location Address City Name:
FORT CARSON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80913-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-526-7844
Provider Business Practice Location Address Fax Number:
719-526-7984
Provider Enumeration Date:
01/18/2006