Provider First Line Business Practice Location Address:
2710 N PLUMTHICKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67226-2152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-640-0724
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2025