Provider First Line Business Practice Location Address:
HWY 160 69 7 JCT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-429-2200
Provider Business Practice Location Address Fax Number:
620-429-1966
Provider Enumeration Date:
01/25/2007