Provider First Line Business Practice Location Address:
107 E 23RD ST
Provider Second Line Business Practice Location Address:
STE 3 OTTAWA ORAL SURGERY LC
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-242-4307
Provider Business Practice Location Address Fax Number:
785-242-4160
Provider Enumeration Date:
10/19/2006