Provider First Line Business Practice Location Address:
524 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSAGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66523-1158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-528-3515
Provider Business Practice Location Address Fax Number:
785-528-3011
Provider Enumeration Date:
02/12/2007