Provider First Line Business Practice Location Address:
503 W 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCPHERSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67460-3215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-241-1425
Provider Business Practice Location Address Fax Number:
620-245-9876
Provider Enumeration Date:
10/24/2005