Provider First Line Business Practice Location Address:
312 E ALTA VISTA
Provider Second Line Business Practice Location Address:
ADDICTION MEDICINE CLINIC
Provider Business Practice Location Address City Name:
OTTUMWA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-684-3170
Provider Business Practice Location Address Fax Number:
641-684-3173
Provider Enumeration Date:
01/10/2006