Provider First Line Business Practice Location Address:
2208 PHILADELPHIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50010-8700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-956-3426
Provider Business Practice Location Address Fax Number:
515-956-3424
Provider Enumeration Date:
05/14/2008