Provider First Line Business Practice Location Address:
710 W 8TH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SCOTT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-223-8590
Provider Business Practice Location Address Fax Number:
620-223-8592
Provider Enumeration Date:
12/11/2006