Provider First Line Business Practice Location Address:
783 7TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-543-5284
Provider Business Practice Location Address Fax Number:
785-543-5285
Provider Enumeration Date:
12/26/2006