Provider First Line Business Practice Location Address:
300 E 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLINWOOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67526-1636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-564-2904
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2007