Provider First Line Business Practice Location Address:
223 N 18TH ST
Provider Second Line Business Practice Location Address:
APT 1
Provider Business Practice Location Address City Name:
CLARINDA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51632-1547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-542-7393
Provider Business Practice Location Address Fax Number:
712-542-8285
Provider Enumeration Date:
12/09/2007