Provider First Line Business Practice Location Address:
306 MAPLE ST
Provider Second Line Business Practice Location Address:
P.O. BOX A
Provider Business Practice Location Address City Name:
AXTELL
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66403-9717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-736-2834
Provider Business Practice Location Address Fax Number:
785-736-2716
Provider Enumeration Date:
08/28/2006