Provider First Line Business Practice Location Address:
300 N AZTEC
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEZUMA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67867-0128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-846-2202
Provider Business Practice Location Address Fax Number:
620-846-7130
Provider Enumeration Date:
08/30/2006