Provider First Line Business Practice Location Address:
606 N MULBERRY RD
Provider Second Line Business Practice Location Address:
TANGLEWOOD MEDICAL CENTER, PA
Provider Business Practice Location Address City Name:
DERBY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67037-3532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-788-3787
Provider Business Practice Location Address Fax Number:
316-788-2618
Provider Enumeration Date:
07/25/2006