Provider First Line Business Practice Location Address:
404 EAST BLOOMINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-351-1483
Provider Business Practice Location Address Fax Number:
319-351-1027
Provider Enumeration Date:
06/03/2006