Provider First Line Business Practice Location Address:
501 N SHERMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRAIRIE CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50228-8666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-994-3562
Provider Business Practice Location Address Fax Number:
515-994-3564
Provider Enumeration Date:
01/05/2007