Provider First Line Business Practice Location Address:
719 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALDWIN CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66006-3015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-594-3505
Provider Business Practice Location Address Fax Number:
785-594-3853
Provider Enumeration Date:
07/05/2007