Provider First Line Business Practice Location Address:
1009 N MARSHALL ST
Provider Second Line Business Practice Location Address:
BOX 219
Provider Business Practice Location Address City Name:
CHAPMAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67431-8821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-922-6525
Provider Business Practice Location Address Fax Number:
785-922-6902
Provider Enumeration Date:
07/20/2006