Provider First Line Business Practice Location Address:
120 W 6TH ST
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-2155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-212-6287
Provider Business Practice Location Address Fax Number:
316-283-1142
Provider Enumeration Date:
09/30/2011