Provider First Line Business Practice Location Address:
211 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGMAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67068-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-532-5113
Provider Business Practice Location Address Fax Number:
620-532-5431
Provider Enumeration Date:
07/11/2014