Provider First Line Business Practice Location Address:
920 S OAK ST STE 2
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
IOWA FALLS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50126-9506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-648-3733
Provider Business Practice Location Address Fax Number:
641-648-3076
Provider Enumeration Date:
12/29/2006