Provider First Line Business Practice Location Address:
200 SW 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-4701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-283-4770
Provider Business Practice Location Address Fax Number:
316-283-4799
Provider Enumeration Date:
10/03/2005