Provider First Line Business Practice Location Address:
1720 W 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANUTE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66720-1932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-431-7300
Provider Business Practice Location Address Fax Number:
620-431-2127
Provider Enumeration Date:
10/31/2006