Provider First Line Business Practice Location Address:
218 E MCKAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRONTENAC
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-231-7242
Provider Business Practice Location Address Fax Number:
620-231-2702
Provider Enumeration Date:
11/28/2006