Provider First Line Business Practice Location Address:
629 W CRAWFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67432-2337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-632-6100
Provider Business Practice Location Address Fax Number:
785-630-5830
Provider Enumeration Date:
08/11/2006