Provider First Line Business Practice Location Address:
240 FISCHER DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-543-9160
Provider Business Practice Location Address Fax Number:
785-543-6425
Provider Enumeration Date:
05/09/2007