Provider First Line Business Practice Location Address:
136 S 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51501-4133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-325-1136
Provider Business Practice Location Address Fax Number:
712-325-1152
Provider Enumeration Date:
02/10/2006