Provider First Line Business Practice Location Address:
510 EAST HIGHWAY 24
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAMEGO
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66547-1504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-456-9195
Provider Business Practice Location Address Fax Number:
785-456-1591
Provider Enumeration Date:
08/17/2006