Provider First Line Business Practice Location Address:
DEPT 3414 1000 E. UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF INTERCOL
Provider Business Practice Location Address City Name:
LARAMIE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-766-5052
Provider Business Practice Location Address Fax Number:
307-766-2112
Provider Enumeration Date:
10/06/2006