Provider First Line Business Practice Location Address:
409 S COCHRAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-877-3305
Provider Business Practice Location Address Fax Number:
785-877-3646
Provider Enumeration Date:
07/05/2006