Provider First Line Business Practice Location Address:
1014 S MT CARMEL PL
Provider Second Line Business Practice Location Address:
1
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-235-1500
Provider Business Practice Location Address Fax Number:
620-235-1508
Provider Enumeration Date:
08/02/2005