Provider First Line Business Practice Location Address:
1221 LARIMER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-1241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-672-6541
Provider Business Practice Location Address Fax Number:
620-672-5275
Provider Enumeration Date:
10/12/2006