Provider First Line Business Practice Location Address:
1400 W. LINCOLN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKIN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67860-9746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-355-1468
Provider Business Practice Location Address Fax Number:
620-355-1469
Provider Enumeration Date:
06/07/2011