Provider First Line Business Practice Location Address:
4245 W. HWY 50
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-343-3366
Provider Business Practice Location Address Fax Number:
620-343-3366
Provider Enumeration Date:
02/06/2013