Provider First Line Business Practice Location Address:
1210 N. WASHINGTON,
Provider Second Line Business Practice Location Address:
CLINIC B
Provider Business Practice Location Address City Name:
PLAINVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67663-1632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-434-2622
Provider Business Practice Location Address Fax Number:
785-434-2577
Provider Enumeration Date:
08/16/2006