Provider First Line Business Practice Location Address:
506 SIXTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EFFINGHAM
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-833-5050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2009