Provider First Line Business Practice Location Address:
121 C ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66968-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-325-2739
Provider Business Practice Location Address Fax Number:
785-325-2751
Provider Enumeration Date:
04/11/2012