Provider First Line Business Practice Location Address:
2138 N KANSAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERAL
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67901-2012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-624-6222
Provider Business Practice Location Address Fax Number:
620-624-5413
Provider Enumeration Date:
06/09/2005