Provider First Line Business Practice Location Address:
1101 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCPHERSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-504-5996
Provider Business Practice Location Address Fax Number:
888-263-5552
Provider Enumeration Date:
06/24/2011