Provider First Line Business Practice Location Address:
416 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITES 2 & 3
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66067-2334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-242-8965
Provider Business Practice Location Address Fax Number:
785-242-6947
Provider Enumeration Date:
04/15/2014