Provider First Line Business Practice Location Address:
1212 DIRR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARSONS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67357-3053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-778-2362
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2025