Provider First Line Business Practice Location Address:
527 COMMERCIAL ST STE 517
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-4081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-342-4473
Provider Business Practice Location Address Fax Number:
620-342-1157
Provider Enumeration Date:
12/02/2006