Provider First Line Business Practice Location Address:
401 S HAMILTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-2534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-672-4500
Provider Business Practice Location Address Fax Number:
620-672-4509
Provider Enumeration Date:
10/02/2009