Provider First Line Business Practice Location Address:
321 CRIMSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALDWIN CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66006-4157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-594-4255
Provider Business Practice Location Address Fax Number:
785-594-2280
Provider Enumeration Date:
04/20/2006