Provider First Line Business Practice Location Address:
1531 COLORADO BLVD
Provider Second Line Business Practice Location Address:
CLEAR CREEK COMMUNITY CENTER
Provider Business Practice Location Address City Name:
IDAHO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80452-3959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-281-3584
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2011