Provider First Line Business Practice Location Address:
328 S 8TH ST LOWR LEVEL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT DODGE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50501-4660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-573-8147
Provider Business Practice Location Address Fax Number:
515-955-8729
Provider Enumeration Date:
12/27/2011