Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Sep 30, 2008
License(s)
39129 (IA), 036143798 (IL), 2017022697 (MO), 2017022697 (MO)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1005 PENNSYLVANIA AVE SUITE 104 | Ottumwa, IA 52501-6413 | 641-682-4594 |
| MAILING | 1005 PENNSYLVANIA AVE SUITE 104 | Ottumwa, IA 52501-6413 | 641-682-4594 |
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