Provider First Line Business Practice Location Address:
29 BLACK COAL DRIVE
Provider Second Line Business Practice Location Address:
FORT WASHAKIE HEALTH CENTER LAB
Provider Business Practice Location Address City Name:
FORT WASHAKIE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-335-5934
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2011