Provider First Line Business Practice Location Address:
330 EAST 24/40 HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TONGANOXIE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66086-0199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-369-2183
Provider Business Practice Location Address Fax Number:
913-845-3629
Provider Enumeration Date:
09/23/2009