Provider First Line Business Practice Location Address:
2701 S. ROUSE
Provider Second Line Business Practice Location Address:
STE. A
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-235-7605
Provider Business Practice Location Address Fax Number:
620-231-0081
Provider Enumeration Date:
09/16/2006