Provider First Line Business Practice Location Address:
106 S 1ST ST
Provider Second Line Business Practice Location Address:
COURTHOUSE BOX 3
Provider Business Practice Location Address City Name:
OSKALOOSA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52577-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-672-2625
Provider Business Practice Location Address Fax Number:
641-676-1053
Provider Enumeration Date:
10/17/2006