Provider First Line Business Practice Location Address:
100 EAST SCHOOL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCANDIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-335-2206
Provider Business Practice Location Address Fax Number:
785-335-2219
Provider Enumeration Date:
11/30/2009