Provider First Line Business Practice Location Address:
212 N IUKA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-1731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-210-8654
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2026