Provider First Line Business Practice Location Address:
1214 1/2 S GILBERT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52240-4506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-358-1844
Provider Business Practice Location Address Fax Number:
319-358-1844
Provider Enumeration Date:
08/09/2005