Provider First Line Business Practice Location Address:
1260 220TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIAWATHA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66434-0380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-742-2222
Provider Business Practice Location Address Fax Number:
785-742-2164
Provider Enumeration Date:
03/15/2007