Provider First Line Business Practice Location Address:
116 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66067-2328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-242-3310
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2006