Provider First Line Business Practice Location Address:
202 N NIPP ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67855-4142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-668-0643
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2026