Provider First Line Business Practice Location Address: 
523 S. SANTA FE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
SALINA
    Provider Business Practice Location Address State Name: 
KS
    Provider Business Practice Location Address Postal Code: 
67401
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
785-823-7213
    Provider Business Practice Location Address Fax Number: 
785-823-6887
    Provider Enumeration Date: 
09/20/2006