Provider First Line Business Practice Location Address:
1400 W 12TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-2516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-342-1242
Provider Business Practice Location Address Fax Number:
620-342-1243
Provider Enumeration Date:
04/21/2015