Provider First Line Business Practice Location Address:
609 LIBERTY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67432-1564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-632-2181
Provider Business Practice Location Address Fax Number:
785-632-2309
Provider Enumeration Date:
04/18/2006