Provider First Line Business Practice Location Address:
1102 S HWY 75
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SABETHA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66534-9531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-284-0088
Provider Business Practice Location Address Fax Number:
785-284-0078
Provider Enumeration Date:
08/09/2005