Provider First Line Business Practice Location Address:
202 W KANSAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ULYSSES
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67880-2034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-356-5870
Provider Business Practice Location Address Fax Number:
620-356-5867
Provider Enumeration Date:
03/17/2006