Provider First Line Business Practice Location Address:
105 W 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-672-7546
Provider Business Practice Location Address Fax Number:
580-824-0676
Provider Enumeration Date:
07/20/2021