Provider First Line Business Practice Location Address:
G11 TASF IOWA STATE UNIVERSITY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50011-3020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-294-2056
Provider Business Practice Location Address Fax Number:
515-294-1967
Provider Enumeration Date:
12/31/2007