Provider First Line Business Practice Location Address:
412 W DOUGLAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLSWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67439-3806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-531-1824
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2026