Provider First Line Business Practice Location Address:
214 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67646-9764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-877-3351
Provider Business Practice Location Address Fax Number:
785-877-2841
Provider Enumeration Date:
07/15/2016