Provider First Line Business Practice Location Address:
1486 S 1ST AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52240-6070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-337-7271
Provider Business Practice Location Address Fax Number:
319-887-2503
Provider Enumeration Date:
03/07/2006