Provider First Line Business Practice Location Address:
322 1/2 COLLEGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOWA FALLS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50126-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-648-6491
Provider Business Practice Location Address Fax Number:
641-648-7138
Provider Enumeration Date:
07/11/2006