Provider First Line Business Practice Location Address:
21 TAFT ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50548-1768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-955-7171
Provider Business Practice Location Address Fax Number:
515-573-7898
Provider Enumeration Date:
03/20/2014