Provider First Line Business Practice Location Address:
536 SOUTHGATE AVE
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:
52240-4453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-358-7399
Provider Business Practice Location Address Fax Number:
319-358-9072
Provider Enumeration Date:
11/01/2006