Provider First Line Business Practice Location Address:
ATHLETIC DEPARTMENT
Provider Second Line Business Practice Location Address:
132 REC ATH FAC
Provider Business Practice Location Address City Name:
AMES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50011-1330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-294-2626
Provider Business Practice Location Address Fax Number:
515-294-2794
Provider Enumeration Date:
12/18/2006