Provider First Line Business Practice Location Address:
934 MAIN ST
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:
66534-1829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-284-3414
Provider Business Practice Location Address Fax Number:
785-284-3040
Provider Enumeration Date:
03/24/2006