Provider First Line Business Practice Location Address:
2110 10TH AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50548-1073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-332-5678
Provider Business Practice Location Address Fax Number:
515-332-4773
Provider Enumeration Date:
02/26/2008