Provider First Line Business Practice Location Address:
323 N MAIN ST
Provider Second Line Business Practice Location Address:
BOX 7
Provider Business Practice Location Address City Name:
KINGMAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67068-1335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-532-4480
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2007