Provider First Line Business Practice Location Address:
201 N 13TH 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:
66053-3520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-206-3691
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2005