Provider First Line Business Practice Location Address:
112 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67054-1724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-723-3112
Provider Business Practice Location Address Fax Number:
620-723-3421
Provider Enumeration Date:
09/27/2021