Provider First Line Business Practice Location Address:
1360 N DODGE 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:
52245-6104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-351-1448
Provider Business Practice Location Address Fax Number:
319-351-9367
Provider Enumeration Date:
07/24/2006