Provider First Line Business Practice Location Address:
402 SOUTH KANSAS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANUTE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-431-7890
Provider Business Practice Location Address Fax Number:
620-431-7927
Provider Enumeration Date:
01/17/2007