Provider First Line Business Practice Location Address:
221 S WASHINGTON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOLA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66749-3252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-365-2524
Provider Business Practice Location Address Fax Number:
620-365-2523
Provider Enumeration Date:
08/29/2006