Provider First Line Business Practice Location Address:
1302 N ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTTUMWA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-684-8636
Provider Business Practice Location Address Fax Number:
641-684-0686
Provider Enumeration Date:
10/24/2006