Provider First Line Business Practice Location Address: 
600 5TH ST
    Provider Second Line Business Practice Location Address: 
SUITE 302
    Provider Business Practice Location Address City Name: 
AMES
    Provider Business Practice Location Address State Name: 
IA
    Provider Business Practice Location Address Postal Code: 
50010-6085
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
515-232-5340
    Provider Business Practice Location Address Fax Number: 
515-232-2070
    Provider Enumeration Date: 
09/06/2011