Provider First Line Business Practice Location Address:
1802 E SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67846-6337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-276-1900
Provider Business Practice Location Address Fax Number:
620-271-0200
Provider Enumeration Date:
03/15/2007