Provider First Line Business Practice Location Address:
496 YUCCA LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-672-7553
Provider Business Practice Location Address Fax Number:
620-672-7554
Provider Enumeration Date:
07/13/2006