Provider First Line Business Practice Location Address:
107 S BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66053-4082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-837-5121
Provider Business Practice Location Address Fax Number:
913-837-5716
Provider Enumeration Date:
02/16/2007