Provider First Line Business Practice Location Address:
160 3RD ST N
Provider Second Line Business Practice Location Address:
BOX 246
Provider Business Practice Location Address City Name:
CENTRAL CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52214-9315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-438-6213
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2008