Provider First Line Business Practice Location Address:
715 CHAPEL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALDWIN CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66006-0041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-594-2737
Provider Business Practice Location Address Fax Number:
785-594-6815
Provider Enumeration Date:
08/02/2006