Provider First Line Business Practice Location Address:
1602 W 15TH AVE STE F
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:
66801-9803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-343-2500
Provider Business Practice Location Address Fax Number:
620-343-2828
Provider Enumeration Date:
07/26/2006