Provider First Line Business Practice Location Address:
25 12TH ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEMARS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-546-7140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2006