Provider First Line Business Practice Location Address:
1102 WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSKALOOSA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66066-4203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-214-4084
Provider Business Practice Location Address Fax Number:
785-214-4107
Provider Enumeration Date:
10/27/2025