Provider First Line Business Practice Location Address:
613 W. NORTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67855637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-952-1738
Provider Business Practice Location Address Fax Number:
620-492-3316
Provider Enumeration Date:
09/06/2018