Provider First Line Business Practice Location Address:
307 N HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
GIRARD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66743-2014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-724-4659
Provider Business Practice Location Address Fax Number:
620-724-6955
Provider Enumeration Date:
06/04/2006