Provider First Line Business Practice Location Address:
1012 POPLAR ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLSVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66092-8881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-883-2462
Provider Business Practice Location Address Fax Number:
785-883-2153
Provider Enumeration Date:
09/21/2006