Provider First Line Business Practice Location Address:
801 E 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLSWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67439-4224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-472-3272
Provider Business Practice Location Address Fax Number:
785-472-3360
Provider Enumeration Date:
12/01/2005