Provider First Line Business Practice Location Address: 
720 MEDICAL CENTER DR
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
NEWTON
    Provider Business Practice Location Address State Name: 
KS
    Provider Business Practice Location Address Postal Code: 
67114-8778
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
316-283-6103
    Provider Business Practice Location Address Fax Number: 
316-283-1333
    Provider Enumeration Date: 
11/24/2021