Provider First Line Business Practice Location Address:
104 SOUTH 6TH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-842-4925
Provider Business Practice Location Address Fax Number:
641-842-3442
Provider Enumeration Date:
05/14/2007