Provider First Line Business Practice Location Address:
420 E. MAIN
Provider Second Line Business Practice Location Address:
BOX 37
Provider Business Practice Location Address City Name:
MOUNT HOPE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-667-2429
Provider Business Practice Location Address Fax Number:
316-667-1150
Provider Enumeration Date:
11/27/2006