Provider First Line Business Practice Location Address:
1301 W 12TH AVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-340-6181
Provider Business Practice Location Address Fax Number:
620-340-6182
Provider Enumeration Date:
09/14/2010