Provider First Line Business Practice Location Address:
321 E 12TH ST
Provider Second Line Business Practice Location Address:
LUCAS STATE OFFICE BUILDING
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50319-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-281-4941
Provider Business Practice Location Address Fax Number:
515-281-4958
Provider Enumeration Date:
03/30/2009