Provider First Line Business Practice Location Address:
526 SOUTHGATE 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:
52240-4426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-354-3824
Provider Business Practice Location Address Fax Number:
319-354-3826
Provider Enumeration Date:
08/17/2006