Provider First Line Business Practice Location Address:
501 E. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSAWATOMIE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-731-1103
Provider Business Practice Location Address Fax Number:
913-642-1554
Provider Enumeration Date:
11/28/2007