Provider First Line Business Practice Location Address:
710 W. 8TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SCOTT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66701-0750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-223-5200
Provider Business Practice Location Address Fax Number:
620-224-3020
Provider Enumeration Date:
09/20/2006