Provider First Line Business Practice Location Address:
1212 CHESTNUT
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-342-8256
Provider Business Practice Location Address Fax Number:
620-412-4316
Provider Enumeration Date:
04/22/2006