Provider First Line Business Practice Location Address:
200 W WEAVER AVE
Provider Second Line Business Practice Location Address:
P O BOX C
Provider Business Practice Location Address City Name:
JOHNSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67855-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-492-6226
Provider Business Practice Location Address Fax Number:
620-492-1326
Provider Enumeration Date:
09/04/2009