Provider First Line Business Practice Location Address:
1130 W HIGHWAY 96
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTT CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67871-6001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-872-7045
Provider Business Practice Location Address Fax Number:
620-302-1236
Provider Enumeration Date:
10/07/2024