Provider First Line Business Practice Location Address:
721 W KANSAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67054-1633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-723-2127
Provider Business Practice Location Address Fax Number:
620-723-1037
Provider Enumeration Date:
10/14/2008