Provider First Line Business Practice Location Address:
2917 W HIGHWAY 50
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-5140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-342-7768
Provider Business Practice Location Address Fax Number:
620-343-9904
Provider Enumeration Date:
06/17/2011