Provider First Line Business Practice Location Address:
108 S. CENTER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASSARIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-667-4280
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2007