Provider First Line Business Practice Location Address:
1305 N 22ND 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:
50501-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-955-4145
Provider Business Practice Location Address Fax Number:
515-955-1731
Provider Enumeration Date:
11/09/2006