Provider First Line Business Practice Location Address:
311 E 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66968-2028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-325-2361
Provider Business Practice Location Address Fax Number:
785-325-2870
Provider Enumeration Date:
09/12/2005