Provider First Line Business Practice Location Address:
840 LAKIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSAGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66523-1159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-528-3773
Provider Business Practice Location Address Fax Number:
785-528-3504
Provider Enumeration Date:
07/26/2006