Provider First Line Business Practice Location Address:
1619 E. 10TH STREET
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:
67114-2512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-755-5871
Provider Business Practice Location Address Fax Number:
620-663-5263
Provider Enumeration Date:
03/27/2007