Provider First Line Business Practice Location Address:
304 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66067-2332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-242-3092
Provider Business Practice Location Address Fax Number:
785-242-0869
Provider Enumeration Date:
10/10/2006