Provider First Line Business Practice Location Address:
1556 S 1ST AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52240-6007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-338-0515
Provider Business Practice Location Address Fax Number:
319-338-0531
Provider Enumeration Date:
03/02/2007