Provider First Line Business Practice Location Address:
3223 HWY 141
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHLAND
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-889-2140
Provider Business Practice Location Address Fax Number:
712-889-2140
Provider Enumeration Date:
10/26/2007