Provider First Line Business Practice Location Address:
712 S MAIN 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:
67124-2631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-672-4135
Provider Business Practice Location Address Fax Number:
620-672-1129
Provider Enumeration Date:
07/09/2006