Provider First Line Business Practice Location Address:
618 COMMERCIAL ST
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:
66801-3969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-343-7746
Provider Business Practice Location Address Fax Number:
620-342-0745
Provider Enumeration Date:
06/10/2009