Provider First Line Business Practice Location Address:
4 SOUTH 1ST STREET
Provider Second Line Business Practice Location Address:
#C
Provider Business Practice Location Address City Name:
LOUISBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-832-0131
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2020