Provider First Line Business Practice Location Address:
485 N KS HWY 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANTHONY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67003-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-914-1200
Provider Business Practice Location Address Fax Number:
620-914-1257
Provider Enumeration Date:
08/30/2005