Provider First Line Business Practice Location Address:
600 SHARP ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUE RAPIDS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66411-1456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-537-9330
Provider Business Practice Location Address Fax Number:
785-776-2437
Provider Enumeration Date:
10/28/2008