Provider First Line Business Practice Location Address:
604 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRALIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66415-9637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-857-3388
Provider Business Practice Location Address Fax Number:
785-857-3349
Provider Enumeration Date:
02/20/2006