Provider First Line Business Practice Location Address:
1130 CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-2549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-343-3533
Provider Business Practice Location Address Fax Number:
620-343-7239
Provider Enumeration Date:
08/30/2006