Provider First Line Business Practice Location Address:
131 W MARKET ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSAGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-528-4136
Provider Business Practice Location Address Fax Number:
785-528-3422
Provider Enumeration Date:
11/28/2006