Provider First Line Business Practice Location Address: 
500 E MARKET ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
IOWA CITY
    Provider Business Practice Location Address State Name: 
IA
    Provider Business Practice Location Address Postal Code: 
52245-2633
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
319-339-7196
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/13/2016