Provider First Line Business Practice Location Address:
1020 N SCHOOL ST
Provider Second Line Business Practice Location Address:
ROUTE 2, BOX 94-C
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67045-1106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-583-7418
Provider Business Practice Location Address Fax Number:
620-583-6621
Provider Enumeration Date:
10/10/2006