Provider First Line Business Practice Location Address:
1034 NORTH HIGHWAY 69
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:
620-232-2273
Provider Business Practice Location Address Fax Number:
620-232-9308
Provider Enumeration Date:
12/06/2006