Provider First Line Business Practice Location Address:
HC 65 BOX 8A
Provider Second Line Business Practice Location Address:
202 S FRISCO
Provider Business Practice Location Address City Name:
COLDWATER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67029-9500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-582-2144
Provider Business Practice Location Address Fax Number:
620-582-2572
Provider Enumeration Date:
07/31/2006