Provider First Line Business Practice Location Address:
1411 W 4TH ST
Provider Second Line Business Practice Location Address:
FAMILY CONSULTATION SERVICES STE C
Provider Business Practice Location Address City Name:
COFFEYVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67337-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-251-6967
Provider Business Practice Location Address Fax Number:
620-251-6967
Provider Enumeration Date:
04/11/2007