Provider First Line Business Practice Location Address:
2107 HIGHWAY 169 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT DODGE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50501-8410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-222-6730
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2023