Provider First Line Business Practice Location Address:
1310 10TH AVE 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:
50548-1112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-332-1627
Provider Business Practice Location Address Fax Number:
515-332-4324
Provider Enumeration Date:
05/20/2020