Provider First Line Business Practice Location Address:
1939 N 11TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARKANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67005-1724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-442-5660
Provider Business Practice Location Address Fax Number:
620-442-5682
Provider Enumeration Date:
06/23/2005