Provider First Line Business Practice Location Address:
424A PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66436-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-364-2952
Provider Business Practice Location Address Fax Number:
785-364-2953
Provider Enumeration Date:
06/18/2006