Provider First Line Business Practice Location Address:
1108 E 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-2060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-672-5584
Provider Business Practice Location Address Fax Number:
620-672-0508
Provider Enumeration Date:
07/26/2017