Provider First Line Business Practice Location Address:
2010 PHILADELPHIA ST
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
AMES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50010-8784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-232-8844
Provider Business Practice Location Address Fax Number:
515-232-8855
Provider Enumeration Date:
08/31/2005