Provider First Line Business Practice Location Address:
602 E 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-2912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-663-7595
Provider Business Practice Location Address Fax Number:
620-663-5263
Provider Enumeration Date:
07/21/2015