Provider First Line Business Practice Location Address:
423 SE 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-4409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-284-2477
Provider Business Practice Location Address Fax Number:
316-283-3937
Provider Enumeration Date:
09/30/2011