Provider First Line Business Practice Location Address:
312 E ALTA VISTA AVE
Provider Second Line Business Practice Location Address:
PSYCHIATRIC MEDICINE SUITE
Provider Business Practice Location Address City Name:
OTTUMWA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52501-1413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-683-4454
Provider Business Practice Location Address Fax Number:
641-683-4450
Provider Enumeration Date:
06/30/2006