Provider First Line Business Practice Location Address:
143 SW 20TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-8140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-967-9669
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2025