Provider First Line Business Practice Location Address:
1011 N 69 HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRONTENAC
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-235-1377
Provider Business Practice Location Address Fax Number:
620-235-1558
Provider Enumeration Date:
06/26/2007