Provider First Line Business Practice Location Address:
131 W MARKET ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
OSAGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66523-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-528-3161
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2011