Provider First Line Business Practice Location Address:
101 S IUKA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-2562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-214-3222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2010