Provider First Line Business Practice Location Address:
222 S KANSAS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSSELL
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67665-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-483-3333
Provider Business Practice Location Address Fax Number:
785-483-0781
Provider Enumeration Date:
08/19/2005