Provider First Line Business Practice Location Address:
810 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALDWIN CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66006-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-594-6412
Provider Business Practice Location Address Fax Number:
785-594-6413
Provider Enumeration Date:
11/14/2006