Provider First Line Business Practice Location Address:
404 EAST 2ND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRAIRIE CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50228-8829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-994-2617
Provider Business Practice Location Address Fax Number:
515-994-2365
Provider Enumeration Date:
12/06/2021