Provider First Line Business Practice Location Address:
715 W 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALSTEAD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67056-2173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-830-2424
Provider Business Practice Location Address Fax Number:
316-830-3030
Provider Enumeration Date:
03/27/2007