Provider First Line Business Practice Location Address:
100 WARTBURG BLVD
Provider Second Line Business Practice Location Address:
SUITE 1392 WARTBURG / WAVERLY SPORTS & WELLNESS CENTER
Provider Business Practice Location Address City Name:
WAVERLY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-352-8436
Provider Business Practice Location Address Fax Number:
319-352-8566
Provider Enumeration Date:
08/03/2006