Provider First Line Business Practice Location Address:
137 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAYSVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67060-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-542-4278
Provider Business Practice Location Address Fax Number:
316-524-4281
Provider Enumeration Date:
02/24/2010