Provider First Line Business Practice Location Address:
1000 LINCOLN ST
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:
66801-2449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-343-2211
Provider Business Practice Location Address Fax Number:
620-342-1021
Provider Enumeration Date:
10/01/2012