Provider First Line Business Practice Location Address:
3204 1ST ST
Provider Second Line Business Practice Location Address:
SUITE L
Provider Business Practice Location Address City Name:
EMMETSBURG
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50536-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-852-2727
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2007