Provider First Line Business Practice Location Address:
115 WEST 5TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-343-2109
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2008