Provider First Line Business Practice Location Address:
3 S BERKLEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66053-3578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-837-3636
Provider Business Practice Location Address Fax Number:
913-837-5641
Provider Enumeration Date:
09/15/2006