Provider First Line Business Practice Location Address:
311 E SPRUCE ST
Provider Second Line Business Practice Location Address:
SUITE 2-A
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67846-5684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-275-3740
Provider Business Practice Location Address Fax Number:
620-275-3020
Provider Enumeration Date:
08/09/2006