Provider First Line Business Practice Location Address:
1428 2ND AVE N
Provider Second Line Business Practice Location Address:
MEDICAL ARTS BLDG
Provider Business Practice Location Address City Name:
FORT DODGE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50501-4119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-573-1145
Provider Business Practice Location Address Fax Number:
515-573-1028
Provider Enumeration Date:
01/04/2006