Provider First Line Business Practice Location Address:
2203 MUSCATINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52240-6632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-337-4928
Provider Business Practice Location Address Fax Number:
319-337-2897
Provider Enumeration Date:
02/15/2006