Provider First Line Business Practice Location Address:
1000 S WASHINGTON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67663-3699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-434-4536
Provider Business Practice Location Address Fax Number:
785-434-2132
Provider Enumeration Date:
12/21/2006