Provider First Line Business Practice Location Address:
1321 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-464-7281
Provider Business Practice Location Address Fax Number:
712-318-5420
Provider Enumeration Date:
01/28/2020