Provider First Line Business Practice Location Address:
136 E. COMMERCIAL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-363-2367
Provider Business Practice Location Address Fax Number:
785-363-2524
Provider Enumeration Date:
09/08/2006