Provider First Line Business Practice Location Address: 
1000 LANGWORTHY ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
DUBUQUE
    Provider Business Practice Location Address State Name: 
IA
    Provider Business Practice Location Address Postal Code: 
52001-7313
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
563-584-3441
    Provider Business Practice Location Address Fax Number: 
563-584-3900
    Provider Enumeration Date: 
05/15/2006