Provider First Line Business Practice Location Address:
100 S CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASSARIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67416-5035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-820-6176
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2011