Provider First Line Business Practice Location Address:
609 N BARTON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-384-7330
Provider Business Practice Location Address Fax Number:
620-384-5437
Provider Enumeration Date:
03/01/2007