Provider First Line Business Practice Location Address:
1002 S LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50138-3155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-842-2151
Provider Business Practice Location Address Fax Number:
641-842-1470
Provider Enumeration Date:
08/04/2006