Provider First Line Business Practice Location Address:
615 W 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARPER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67058-1214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-896-7306
Provider Business Practice Location Address Fax Number:
620-896-7127
Provider Enumeration Date:
03/31/2006