Provider First Line Business Practice Location Address:
304 E 23RD 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:
66701-3008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-830-5357
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2022