Provider First Line Business Practice Location Address:
1011 S MOUNT CARMEL PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66762-6604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-231-6160
Provider Business Practice Location Address Fax Number:
620-235-0175
Provider Enumeration Date:
03/23/2006