Provider First Line Business Practice Location Address:
203 WATSON ST
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-3066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-672-1002
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2006