Provider First Line Business Practice Location Address:
405 N MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-384-5252
Provider Business Practice Location Address Fax Number:
620-384-5301
Provider Enumeration Date:
12/22/2005