Provider First Line Business Practice Location Address:
211 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66414-9714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-836-7202
Provider Business Practice Location Address Fax Number:
785-836-7208
Provider Enumeration Date:
08/18/2006