Provider First Line Business Practice Location Address:
406 N 3RD ST
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
MARYSVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66508-1496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-562-3907
Provider Business Practice Location Address Fax Number:
785-587-4377
Provider Enumeration Date:
02/12/2009