Provider First Line Business Practice Location Address:
621 E OKLAHOMA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ULYSSES
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67880-2819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-356-5577
Provider Business Practice Location Address Fax Number:
620-356-5522
Provider Enumeration Date:
07/20/2006