Provider First Line Business Practice Location Address:
29796 272ND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEXTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67038-9076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-876-3227
Provider Business Practice Location Address Fax Number:
620-876-3233
Provider Enumeration Date:
04/03/2007