Provider First Line Business Practice Location Address:
BOX 89
Provider Second Line Business Practice Location Address:
RURAL ROUTE 3
Provider Business Practice Location Address City Name:
LARNED
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67550-0089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-285-4576
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2006