Provider First Line Business Practice Location Address:
202 S 3RD ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66861-1659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-382-3271
Provider Business Practice Location Address Fax Number:
620-382-3861
Provider Enumeration Date:
06/01/2005