Provider First Line Business Practice Location Address:
1104 OHIO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67356-9059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-795-4429
Provider Business Practice Location Address Fax Number:
620-795-2748
Provider Enumeration Date:
07/30/2007