Provider First Line Business Practice Location Address:
124 COMMODORE ST STE B
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:
67124-2995
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-672-6454
Provider Business Practice Location Address Fax Number:
620-672-3488
Provider Enumeration Date:
02/25/2020