Provider First Line Business Practice Location Address:
6 N MAIN 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:
67526-1638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-564-2555
Provider Business Practice Location Address Fax Number:
620-564-2711
Provider Enumeration Date:
10/19/2005