Provider First Line Business Practice Location Address:
1920 RUE ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51503-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-329-8932
Provider Business Practice Location Address Fax Number:
712-329-8934
Provider Enumeration Date:
07/20/2006