Provider First Line Business Practice Location Address:
115 S 29TH 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:
50501-2951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-576-5320
Provider Business Practice Location Address Fax Number:
515-576-4078
Provider Enumeration Date:
06/27/2006