Provider First Line Business Practice Location Address:
112 N 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SABETHA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66534-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-284-2323
Provider Business Practice Location Address Fax Number:
785-284-0075
Provider Enumeration Date:
09/15/2005