Provider First Line Business Practice Location Address:
302 E. AVE. A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-384-7424
Provider Business Practice Location Address Fax Number:
620-384-7424
Provider Enumeration Date:
07/06/2006