Provider First Line Business Practice Location Address:
1720 S SANTA FE AVE
Provider Second Line Business Practice Location Address:
BOX 126
Provider Business Practice Location Address City Name:
CHANUTE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-431-0898
Provider Business Practice Location Address Fax Number:
620-431-0962
Provider Enumeration Date:
10/02/2006