Provider First Line Business Practice Location Address:
32 W MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANUTE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66720-0307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-043-1482
Provider Business Practice Location Address Fax Number:
620-431-6959
Provider Enumeration Date:
11/29/2006