Provider First Line Business Practice Location Address:
710 W 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SCOTT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66701-2404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-223-5200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2005