Provider First Line Business Practice Location Address:
1015 DUFF AVE
Provider Second Line Business Practice Location Address:
MEDICAL ARTS BLDG.
Provider Business Practice Location Address City Name:
AMES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50010-5733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-232-4236
Provider Business Practice Location Address Fax Number:
515-232-4267
Provider Enumeration Date:
08/27/2006