Provider First Line Business Practice Location Address:
629 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSAGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66523-1159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-528-0144
Provider Business Practice Location Address Fax Number:
785-528-0124
Provider Enumeration Date:
08/31/2006