Provider First Line Business Practice Location Address:
3 N 17TH ST
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:
50501-4223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-573-2441
Provider Business Practice Location Address Fax Number:
515-573-7228
Provider Enumeration Date:
12/06/2005