Provider First Line Business Practice Location Address:
675 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67661-2138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-543-2202
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006