Provider First Line Business Practice Location Address:
118 E 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-1931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-281-9700
Provider Business Practice Location Address Fax Number:
316-281-9701
Provider Enumeration Date:
02/23/2024