Provider First Line Business Practice Location Address:
413 COMMERCIAL ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENLEAF
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-747-2251
Provider Business Practice Location Address Fax Number:
785-747-2254
Provider Enumeration Date:
05/11/2007