Provider First Line Business Practice Location Address:
334 IOWA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66748-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-473-1002
Provider Business Practice Location Address Fax Number:
620-473-3020
Provider Enumeration Date:
04/06/2007