Provider First Line Business Practice Location Address:
1111 E SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67846-5958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-276-7689
Provider Business Practice Location Address Fax Number:
620-276-6117
Provider Enumeration Date:
10/18/2006