Provider First Line Business Practice Location Address:
1825 LOGAN AVE
Provider Second Line Business Practice Location Address:
EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
WATERLOO
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50703-1916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-235-3697
Provider Business Practice Location Address Fax Number:
319-235-3844
Provider Enumeration Date:
06/29/2009