Provider First Line Business Practice Location Address:
615 S MONROE AVE
Provider Second Line Business Practice Location Address:
SHOPKO EYECARE CENTER
Provider Business Practice Location Address City Name:
MASON CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50401-5061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-424-8271
Provider Business Practice Location Address Fax Number:
641-424-2359
Provider Enumeration Date:
08/17/2005