Provider First Line Business Practice Location Address:
250 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:
67661-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-540-4118
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2009