Provider First Line Business Practice Location Address:
616 COMMERCIAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-343-6111
Provider Business Practice Location Address Fax Number:
620-342-0451
Provider Enumeration Date:
04/23/2009