Provider First Line Business Practice Location Address:
200 E. CENTENNIAL DR.
Provider Second Line Business Practice Location Address:
SUITE 13
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-231-1068
Provider Business Practice Location Address Fax Number:
620-231-2792
Provider Enumeration Date:
10/13/2006