Provider First Line Business Practice Location Address:
507 5TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENLEAF
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-747-2858
Provider Business Practice Location Address Fax Number:
785-747-2212
Provider Enumeration Date:
12/08/2005