Provider First Line Business Practice Location Address:
430 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSSSVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-584-6722
Provider Business Practice Location Address Fax Number:
785-584-6513
Provider Enumeration Date:
06/16/2005