Provider First Line Business Practice Location Address:
602 LIBERTY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSKALOOSA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66066-0368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-863-2208
Provider Business Practice Location Address Fax Number:
785-863-2967
Provider Enumeration Date:
08/31/2005