Provider First Line Business Practice Location Address:
229 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-3442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-283-0870
Provider Business Practice Location Address Fax Number:
316-282-2500
Provider Enumeration Date:
07/29/2005