Provider First Line Business Practice Location Address:
704 S 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSAGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66523-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-948-4619
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2026