Provider First Line Business Practice Location Address:
611 1ST AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50548-1713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-332-5414
Provider Business Practice Location Address Fax Number:
515-332-5415
Provider Enumeration Date:
06/09/2006