Provider First Line Business Practice Location Address:
313 NEMAHA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAILEYVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66404-9402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-336-2326
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2009