Provider First Line Business Practice Location Address:
220 LAFAYETTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52240-1746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-351-9760
Provider Business Practice Location Address Fax Number:
319-887-2537
Provider Enumeration Date:
12/29/2006