Provider First Line Business Practice Location Address:
1624 RURAL ST
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:
66801-5548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-487-4141
Provider Business Practice Location Address Fax Number:
620-208-9393
Provider Enumeration Date:
10/10/2008