Provider First Line Business Practice Location Address:
109 W JAYNE ST
Provider Second Line Business Practice Location Address:
UIHC LONE TREE FAMILY PRACTICE
Provider Business Practice Location Address City Name:
LONE TREE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52755-0417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-629-4214
Provider Business Practice Location Address Fax Number:
319-629-4619
Provider Enumeration Date:
10/06/2005