Provider First Line Business Practice Location Address:
115A SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
BOX 471
Provider Business Practice Location Address City Name:
MELCHER
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50163-0471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-947-2068
Provider Business Practice Location Address Fax Number:
641-947-2068
Provider Enumeration Date:
04/02/2007