Provider First Line Business Practice Location Address:
112 CENTER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIME SPRINGS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52155-0062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-566-2686
Provider Business Practice Location Address Fax Number:
563-566-2686
Provider Enumeration Date:
08/03/2005