Provider First Line Business Practice Location Address:
223 6TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
OSAWATOMIE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66064-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-755-2081
Provider Business Practice Location Address Fax Number:
913-755-2083
Provider Enumeration Date:
10/07/2014