Provider First Line Business Practice Location Address:
603 S 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SABETHA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66534-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-284-2121
Provider Business Practice Location Address Fax Number:
785-284-1514
Provider Enumeration Date:
06/18/2020