Provider First Line Business Practice Location Address:
1101 COMMERCIAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-2989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-340-0317
Provider Business Practice Location Address Fax Number:
620-343-3033
Provider Enumeration Date:
10/28/2009