Provider First Line Business Practice Location Address:
105 WEST WASHINGTON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST FRANCIS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67756-0664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-332-2177
Provider Business Practice Location Address Fax Number:
785-332-3555
Provider Enumeration Date:
06/16/2005