Provider First Line Business Practice Location Address:
313 EAST C AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHASE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-938-2913
Provider Business Practice Location Address Fax Number:
620-938-2622
Provider Enumeration Date:
10/29/2009