Provider First Line Business Practice Location Address:
JACOBSON ATHLETIC BUILDING
Provider Second Line Business Practice Location Address:
1800 SOUTH 4TH STREET
Provider Business Practice Location Address City Name:
AMES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50011-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-294-7029
Provider Business Practice Location Address Fax Number:
515-294-6554
Provider Enumeration Date:
10/02/2006