Provider First Line Business Practice Location Address:
201 N MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAKEENEY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-743-6348
Provider Business Practice Location Address Fax Number:
785-743-5428
Provider Enumeration Date:
11/15/2006