Provider First Line Business Practice Location Address:
1050 15TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50548-1076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-332-7660
Provider Business Practice Location Address Fax Number:
515-332-7646
Provider Enumeration Date:
04/12/2012