Provider First Line Business Practice Location Address:
809 E ELK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOWARD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67349-0566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-374-2277
Provider Business Practice Location Address Fax Number:
620-374-3540
Provider Enumeration Date:
12/02/2005