Provider First Line Business Practice Location Address:
943 S GILBERT ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52240-4742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-338-2273
Provider Business Practice Location Address Fax Number:
319-338-1225
Provider Enumeration Date:
09/17/2006