Provider First Line Business Practice Location Address:
1200 S. BROADWAY ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66053-3607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-837-2916
Provider Business Practice Location Address Fax Number:
913-837-5782
Provider Enumeration Date:
11/16/2005