Provider First Line Business Practice Location Address:
700 EAST 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IDA GROVE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-364-3101
Provider Business Practice Location Address Fax Number:
712-364-3102
Provider Enumeration Date:
08/12/2006