Provider First Line Business Practice Location Address:
240 W 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORDIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66901-2817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-243-2345
Provider Business Practice Location Address Fax Number:
785-243-7231
Provider Enumeration Date:
05/24/2005