Provider First Line Business Practice Location Address:
115 GRAND AVENUE CT
Provider Second Line Business Practice Location Address:
COLLEGE OF PHARMACY SUITE S511 PHAR
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52246-2508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-335-8878
Provider Business Practice Location Address Fax Number:
319-353-5646
Provider Enumeration Date:
08/02/2005