Provider First Line Business Practice Location Address:
114 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITH CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66967-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-282-6933
Provider Business Practice Location Address Fax Number:
785-282-3550
Provider Enumeration Date:
09/27/2006