Provider First Line Business Practice Location Address:
RURAL ROUTE 3
Provider Second Line Business Practice Location Address:
BOX 89
Provider Business Practice Location Address City Name:
LARNED
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67550-9365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-285-4580
Provider Business Practice Location Address Fax Number:
620-285-4579
Provider Enumeration Date:
07/28/2006