Provider First Line Business Practice Location Address:
2620 N KENTUCKY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOLA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66749-1940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-365-6002
Provider Business Practice Location Address Fax Number:
620-365-3510
Provider Enumeration Date:
02/08/2007