Provider First Line Business Practice Location Address:
HWY 6 WEST 2000 8TH ST.
Provider Second Line Business Practice Location Address:
LANTERN PARK PLAZA
Provider Business Practice Location Address City Name:
CORALVILLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-351-3880
Provider Business Practice Location Address Fax Number:
319-466-9167
Provider Enumeration Date:
06/27/2006