Provider First Line Business Practice Location Address:
1001 12TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-604-6618
Provider Business Practice Location Address Fax Number:
515-604-6627
Provider Enumeration Date:
06/08/2010