Provider First Line Business Practice Location Address:
1201 S 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66053-8405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-207-9079
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2026