Provider First Line Business Practice Location Address:
1600 MORGAN ST
Provider Second Line Business Practice Location Address:
1ST FL CLINICAL STE
Provider Business Practice Location Address City Name:
KEOKUK
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52632-3456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-524-7150
Provider Business Practice Location Address Fax Number:
319-526-8817
Provider Enumeration Date:
11/21/2005