Provider First Line Business Practice Location Address:
1112 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-1838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-327-5063
Provider Business Practice Location Address Fax Number:
316-212-0124
Provider Enumeration Date:
03/25/2006