Provider First Line Business Practice Location Address:
2600 S 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51501-7541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-322-7354
Provider Business Practice Location Address Fax Number:
712-322-7419
Provider Enumeration Date:
01/26/2007