Provider First Line Business Practice Location Address:
1706 NORTH 16TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-322-3111
Provider Business Practice Location Address Fax Number:
712-322-2715
Provider Enumeration Date:
03/26/2007