Provider First Line Business Practice Location Address:
582 S OHIO STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACINA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-827-4114
Provider Business Practice Location Address Fax Number:
785-827-2144
Provider Enumeration Date:
10/02/2006