Provider First Line Business Practice Location Address:
3202 1ST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMMETSBURG
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-852-2054
Provider Business Practice Location Address Fax Number:
712-852-2729
Provider Enumeration Date:
03/26/2007