Provider First Line Business Practice Location Address:
11 NO. 20TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT DODGE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-955-2232
Provider Business Practice Location Address Fax Number:
515-955-8794
Provider Enumeration Date:
05/09/2011