Provider First Line Business Practice Location Address:
110 W. RAILROAD AVE
Provider Second Line Business Practice Location Address:
BOX 48
Provider Business Practice Location Address City Name:
LAKIN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67860-0048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
162-035-5621
Provider Business Practice Location Address Fax Number:
620-355-8043
Provider Enumeration Date:
03/27/2007