Provider First Line Business Practice Location Address:
2401 S. TUCKER AVE.
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-231-2490
Provider Business Practice Location Address Fax Number:
620-231-3920
Provider Enumeration Date:
03/08/2007