Provider First Line Business Practice Location Address:
2401 SOUTH TUCKER AVE
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-235-1043
Provider Business Practice Location Address Fax Number:
620-231-6555
Provider Enumeration Date:
08/28/2006