Provider First Line Business Practice Location Address:
707 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANTHONY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67003-2752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-842-5596
Provider Business Practice Location Address Fax Number:
620-842-3521
Provider Enumeration Date:
07/18/2006