Provider First Line Business Practice Location Address:
124 W 6TH ST
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:
66901-2820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-614-3492
Provider Business Practice Location Address Fax Number:
785-340-3277
Provider Enumeration Date:
12/19/2011