Provider First Line Business Practice Location Address:
17 OLIVE ST.
Provider Second Line Business Practice Location Address:
BOX 207
Provider Business Practice Location Address City Name:
CONCORDIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66901-4934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-243-4236
Provider Business Practice Location Address Fax Number:
785-243-6119
Provider Enumeration Date:
11/18/2005