Provider First Line Business Practice Location Address:
2108 HORTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SCOTT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66701-3141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-223-2700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2019