Provider First Line Business Practice Location Address:
1150 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67661-1743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-554-2809
Provider Business Practice Location Address Fax Number:
785-543-6302
Provider Enumeration Date:
05/17/2010