Provider First Line Business Practice Location Address:
1323 GEORGIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66748-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-431-2500
Provider Business Practice Location Address Fax Number:
620-473-6380
Provider Enumeration Date:
08/05/2014