Provider First Line Business Practice Location Address:
2510 EAST 15TH ST SUITE 2
Provider Second Line Business Practice Location Address:
WYOMING MEDICAL CENTER
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-577-2124
Provider Business Practice Location Address Fax Number:
307-234-0306
Provider Enumeration Date:
11/01/2006