Provider First Line Business Practice Location Address: 
1215 DUFF AVE
    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: 
50010-5400
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
515-232-7315
    Provider Business Practice Location Address Fax Number: 
515-232-8419
    Provider Enumeration Date: 
06/12/2006