Provider First Line Business Practice Location Address: 
601 HIGHWAY 6 W
    Provider Second Line Business Practice Location Address: 
PHARMACY (119)
    Provider Business Practice Location Address City Name: 
IOWA CITY
    Provider Business Practice Location Address State Name: 
IA
    Provider Business Practice Location Address Postal Code: 
52246-2292
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
319-338-0581
    Provider Business Practice Location Address Fax Number: 
319-887-4951
    Provider Enumeration Date: 
08/15/2005