Provider First Line Business Practice Location Address:
123 N LINN ST
Provider Second Line Business Practice Location Address:
SUITE 2C
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52245-2143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-354-7394
Provider Business Practice Location Address Fax Number:
319-354-0939
Provider Enumeration Date:
08/16/2006