Provider First Line Business Practice Location Address:
20 N 29TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT DODGE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50501-2990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-227-7491
Provider Business Practice Location Address Fax Number:
888-594-7231
Provider Enumeration Date:
09/15/2010