Provider First Line Business Practice Location Address:
520 N SUMMIT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARKANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-442-1111
Provider Business Practice Location Address Fax Number:
620-442-2628
Provider Enumeration Date:
06/10/2006