Provider First Line Business Practice Location Address:
601 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRETTY PRAIRIE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67570-9202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-459-6822
Provider Business Practice Location Address Fax Number:
620-459-7277
Provider Enumeration Date:
09/17/2010