Provider First Line Business Practice Location Address:
1212 5TH AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50548-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-890-2787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2007