Provider First Line Business Practice Location Address:
1298 HIGHWAY 14
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLSWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67439-8662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-472-2560
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2007