Provider First Line Business Practice Location Address:
108 EAST MARKET ST
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:
52245-1733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-338-1171
Provider Business Practice Location Address Fax Number:
319-337-8350
Provider Enumeration Date:
04/06/2007