Provider First Line Business Practice Location Address:
1302 PRAIRIE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67467-8533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-527-1023
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2025