Provider First Line Business Practice Location Address:
215 OHIO AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOWA FALLS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-648-2255
Provider Business Practice Location Address Fax Number:
641-648-5600
Provider Enumeration Date:
12/14/2006