Provider First Line Business Practice Location Address:
520 WASHINGTON ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORDIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66901-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-243-4164
Provider Business Practice Location Address Fax Number:
785-243-4164
Provider Enumeration Date:
09/20/2006