Provider First Line Business Practice Location Address:
120 W OSAGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEDAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67361-1518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-725-3122
Provider Business Practice Location Address Fax Number:
620-725-5395
Provider Enumeration Date:
07/25/2006