Provider First Line Business Practice Location Address:
705 N HIGHSCHOOL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66725-9775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-429-8445
Provider Business Practice Location Address Fax Number:
620-429-8447
Provider Enumeration Date:
12/27/2011