Provider First Line Business Practice Location Address:
915 HORTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SCOTT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66701-2437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-896-6400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2007