Provider First Line Business Practice Location Address:
320 E OKLAHOMA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ULYSSES
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67880-0514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-356-3400
Provider Business Practice Location Address Fax Number:
620-356-4512
Provider Enumeration Date:
03/14/2006