Provider First Line Business Practice Location Address: 
2814 US HIGHWAY 24
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HILL CITY
    Provider Business Practice Location Address State Name: 
KS
    Provider Business Practice Location Address Postal Code: 
67642-1482
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
785-421-2135
    Provider Business Practice Location Address Fax Number: 
785-421-5657
    Provider Enumeration Date: 
10/05/2009