Provider First Line Business Practice Location Address:
1210 3RD AVENUE SOUTH
Provider Second Line Business Practice Location Address:
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-955-4092
Provider Business Practice Location Address Fax Number:
515-576-4240
Provider Enumeration Date:
02/06/2007