Provider First Line Business Practice Location Address:
55 SCHOOL ST
Provider Second Line Business Practice Location Address:
BOX 265
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50047-8782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-989-0889
Provider Business Practice Location Address Fax Number:
515-989-9348
Provider Enumeration Date:
05/15/2006