Provider First Line Business Practice Location Address:
135 1ST ST. NW
Provider Second Line Business Practice Location Address:
BOX 278
Provider Business Practice Location Address City Name:
PRIMGHAR
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51245-0278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-957-2460
Provider Business Practice Location Address Fax Number:
712-957-1013
Provider Enumeration Date:
11/07/2006