Provider First Line Business Practice Location Address:
100 E WASHINGTON, STE B
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:
66066-0086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-886-4125
Provider Business Practice Location Address Fax Number:
785-886-4135
Provider Enumeration Date:
07/05/2006