Provider First Line Business Practice Location Address:
1501 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66067-3802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-242-4100
Provider Business Practice Location Address Fax Number:
785-242-4121
Provider Enumeration Date:
08/30/2006